RESUMEN
A 17-year-old girl affected by Seckel syndrome and multiple intracranial aneurysms is reported. Cerebral hemorrhage was the reason for the diagnostic work-up. The aneurysms were surgically treated. The main features of the syndrome, technical problems encountered during surgery and the prognosis of this condition are discussed.
Asunto(s)
Anomalías Múltiples/genética , Anomalías Craneofaciales/genética , Aneurisma Intracraneal/genética , Anomalías Múltiples/diagnóstico por imagen , Anomalías Múltiples/cirugía , Adolescente , Encéfalo/anomalías , Encéfalo/cirugía , Angiografía Cerebral , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/genética , Hemorragia Cerebral/cirugía , Aberraciones Cromosómicas/genética , Trastornos de los Cromosomas , Anomalías Craneofaciales/diagnóstico por imagen , Anomalías Craneofaciales/cirugía , Femenino , Genes Recesivos/genética , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Reoperación , SíndromeRESUMEN
PURPOSE: To determine sensitivity, specificity and diagnostic accuracy of spiral CT angiography (S-CTA) compared to Digital Subtraction Angiography (DSA). MATERIALS AND METHODS: We studied 40 patients with suspected cerebro-vascular insufficiency by carotid stenosis. Diagnostic examinations by means of S-CTA and DSA were carried out within 24 hours of each other. Twelve of these patients underwent thromboendoarterectomy (TEA). Prospeed SX GE was used for S-CTA. Post-processing was performed using Maximum Intensity Projection (MIP) after deleting osteo-muscular structures and CT angiograms were displayed in an oblique anterior view at an angle of 10 degrees-15 degrees along the longitudinal axis. For DSA examinations, a Siemens Politron 1000 VR unit was used. RESULTS: In this study S-CTA showed values of sensitivity, specificity and diagnostic accuracy of 88%, 100% and 96%, respectively. CONCLUSIONS: In the future, with the improvement of non-invasive techniques (S-CTA, MRA), DSA should be replaced, as the gold-standard, in the evaluation of stenotic disease of the carotid bifurcation.
Asunto(s)
Estenosis Carotídea/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Angiografía/métodos , Angiografía de Substracción Digital , Isquemia Encefálica/diagnóstico por imagen , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Femenino , Predicción , Humanos , Procesamiento de Imagen Asistido por Computador , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Intensificación de Imagen Radiográfica/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The Authors report their personal experience with postoperative neuroradiologic studies in surgical patients with a herniated disk and/or degenerative cervical spondylosis. Twenty-six patients were enrolled: 16 of them underwent anterior diskectomy, 7 posterior decompressive laminectomy and 3 vertebral body removal. The patients were submitted to pre- and postoperative MRI with high field equipment (Signa 1.5 T, General Electrics), using sagittal SE T1- (TR/TE 360/15), PD and T2-weighted (TR/TE/FA 2000/40/120) sequences and T2-weighted GE axial sequences (TR/TE/FA 400/34/30). FSE sequences (TR/TE/ETL 4000/95/8) were used in 15 cases instead of the above T2-weighted SE sequences. The main postoperative MR findings were analyzed. In particular, the morphological and signal features of bone grafts, of vertebral end-plates, of the subchondral bone and of the surgical site were studied. After anterior diskectomy, the most frequent MR features were massive signal changes in the bone graft and lower vertebral plates, which were hypointense in T1 and hyperintense in T2; the adjacent subchondral bone also exhibited signal changes. Other postoperative MR findings accounted for early postoperative mobility (4 cases of persistent myelomalacia and 3 of bone graft fracture with consequent spinal instability) and late mobility (2 cases of herniated disk, 5 of spinal stenosis and one pseudomeningocele). The main limitation of MRI in postoperative cervical spine studies was the presence of ferromagnetic artifacts during SE, and even more GE, sequences; these artifacts were the main cause of misdiagnoses. In our experience, this troublesome limitation was overcome with FSE sequences but diagnostic accuracy remained poor in 4 patients. MRI, thanks to its multiparametric and multiplanar yield, is the gold standard for the examination of several early and late postoperative features and of postoperative mobility in the cervical spine. Moreover, T2-weighted FSE acquisitions are better than conventional SE to this purpose, because examination time is shorter, myelographic effect is improved and the sensitivity to ferromagnetic artifacts reduced.
Asunto(s)
Vértebras Cervicales/patología , Vértebras Cervicales/cirugía , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/cirugía , Osteofitosis Vertebral/patología , Osteofitosis Vertebral/cirugía , Adulto , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/patologíaRESUMEN
The authors report a case of mycotic aneurysm surgically treated by means of the Suetens-Gybels-Vandermeulen angiographic localizer system. The major advantages of this technique are reported.
Asunto(s)
Aneurisma Infectado/cirugía , Angiografía Cerebral/métodos , Aneurisma Intracraneal/cirugía , Micosis/cirugía , Técnicas Estereotáxicas , Adulto , Aneurisma Infectado/diagnóstico por imagen , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Micosis/diagnóstico por imagenRESUMEN
The authors present a case of a nine month-old baby with hypersecretive congenital hydrocephalus. The CSF overproduction was the result of a rare abnormality of the choroid plexus, a villous hypertrophy of the right ventricular choroid plexus and a left ventricular plexus papilloma. Surgical removal of the plexus papilloma and the plexectomy of the hypertrophic ventricular structure did not ameliorate the hydrocephalus, which has been controlled after a biventricular-peritoneal shunt. The physiopathological relationship between hydrocephalus and choroid plexus abnormalities are reported. The importance of an early diagnosis and treatment is stressed. Both hydrocephalus and choroid plexus pathology may represent a cause of psychomotor delay, for the little patient the effects of which is investigated in this paper.
Asunto(s)
Glioma/diagnóstico , Hidrocefalia/diagnóstico , Angiografía Cerebral , Ventrículos Cerebrales/anomalías , Ventrículos Cerebrales/cirugía , Craneotomía , Femenino , Lateralidad Funcional , Glioma/complicaciones , Glioma/cirugía , Humanos , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/etiología , Lactante , Imagen por Resonancia Magnética , Trastornos Psicomotores/etiología , Derivación VentriculoperitonealRESUMEN
A series of 33 children affected by low grade gliomas and epilepsy is reported. Seizures are often the only symptom of these patients; intracranial hypertension and focal neurological signs may be present too. All children were operated on; tumor removal was performed in 21 cases, tumor removal associated with corticectomy and/or lobectomy was performed in 12 patients. The treatment of epilepsy has been more effective in the first group of patients with only lesionectomy than in the second one, in which neoplasm removal was coupled with nervous system tissue asportation.
Asunto(s)
Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/cirugía , Epilepsia/complicaciones , Glioma/complicaciones , Glioma/cirugía , Adolescente , Astrocitoma/complicaciones , Astrocitoma/mortalidad , Astrocitoma/cirugía , Neoplasias Encefálicas/mortalidad , Niño , Preescolar , Femenino , Lóbulo Frontal , Glioma/mortalidad , Humanos , Masculino , Oligodendroglioma/complicaciones , Oligodendroglioma/mortalidad , Oligodendroglioma/cirugía , Lóbulo Parietal , Lóbulo TemporalRESUMEN
The authors report on 51 infants with intracranial tumours treated in an eleven-year period; these infants represent 13% of the total population of children with intracranial tumours who have been operated on in the same institution during the same period of time. Males (28 cases) were slightly more frequent. Astrocytomas (17 cases), medulloblastomas (12 cases), and ependymal tumours (5 cases) were the commonest histologic types. Signs and symptoms of increased intracranial pressure were by far the most frequent clinical manifestations, followed by seizure disorders. Thirty tumours were localized within the supratentorial, and 21 within the subtentorial compartment. The parasellar region (10 cases) and the lateral cerebral ventricles (8 cases) for the supratentorial tumours, the inferior cerebellar vermis and fourth ventricle (13 cases) for the infratentorial tumours appeared to be the preferred topographic locations. Craniotomies were carried out in 44 infants, with a total or radical removal of the tumour in 19 cases, a subtotal removal in 6 cases, and a partial removal in 17 cases. In 3 cases only a biopsy procedure was performed. Twenty-nine of these patients required an ancillary procedure such as CSF shunting. Three subjects underwent a biopsy procedure and 1 infant the insertion of a CSF shunting device only. Surgery was not performed in 5 cases. Overall, there were two surgical deaths. Two infants died before any surgical treatment could be performed. Radiation therapy was administered to 9 patients when they had reached three years of age. Chemotherapy was given to 21 infants, according to various chemotherapeutic protocols. During the postoperative period 20 deaths (39%) were recorded. Two patients were lost to follow-up. From 1 to 10 years after the operation, 29 patients are still alive, 14 of them (28%) with a normal psychomotor development, 10 (20%) with some neurological or mental deficits, and 5 (10%) with severe psychomotor retardation. There was no apparent correlation in this series between late outcomes and the histological type of the tumour.
Asunto(s)
Neoplasias Encefálicas/congénito , Astrocitoma/congénito , Astrocitoma/mortalidad , Astrocitoma/patología , Astrocitoma/cirugía , Encéfalo/patología , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Neoplasias Cerebelosas/congénito , Neoplasias Cerebelosas/mortalidad , Neoplasias Cerebelosas/patología , Neoplasias Cerebelosas/cirugía , Craneotomía , Ependimoma/congénito , Ependimoma/mortalidad , Ependimoma/patología , Ependimoma/cirugía , Femenino , Estudios de Seguimiento , Glioma/mortalidad , Glioma/patología , Glioma/cirugía , Humanos , Hidrocefalia/mortalidad , Hidrocefalia/patología , Hidrocefalia/cirugía , Lactante , Recién Nacido , Masculino , Meduloblastoma/congénito , Meduloblastoma/mortalidad , Meduloblastoma/patología , Meduloblastoma/cirugía , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Examen Neurológico , Reoperación , Tasa de SupervivenciaRESUMEN
Spinal lipomas account for 5% of the tumors of the spinal cord, frequently present already at birth. Most commonly they are associated with forms of dysraphism, but lipomas without bony involvement are considered dysembriogenetic lesions too. Children with lipoma frequently have intact neurological functions, but may become symptomatic later on. Diagnosis is possible also in neurologically intact patients because of skin lesions or subcutaneous masses. Many surgeons suggest early surgery to prevent injury to neural structures from traction due to cord tethering; others prefer to wait for the rise of any symptom before considering surgery. However, neurological recovery after surgery is rarely observed, and, when present, is always partial; the primary goal of surgery is to stop the clinical progression through the detethering of the cord.
Asunto(s)
Lipoma , Neoplasias de la Médula Espinal , Niño , Preescolar , Humanos , Lipoma/diagnóstico , Lipoma/embriología , Lipoma/patología , Lipoma/terapia , Defectos del Tubo Neural/complicaciones , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/embriología , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/terapiaRESUMEN
Two hundred eight patients with non-tumoral congenital hydrocephalus underwent CSF shunting below the age of one month. Ultrasonography was the most frequently utilized tool; hydrocephalus was recognized during pregnancy in 52% of the cases. Hydrocephalus was associated with myelomeningocele in 97 infants; in 38 subjects ventricular dilation was secondary to aqueductal stenosis. Post-hemorrhagic and post-infective hydrocephalus accounted for only 20 and 13 cases respectively. At the follow-up observation, a normal psychomotor development was recorded in 67.3% of the cases. Seventeen patients died. CSF infection was the most common cause of death (41%); in 6 patients the exitus was determined by the natural evolution of congenital associated malformations. Shunt revision did not influence the morbidity and the mortality significantly. On the other hand, CSF infections appeared to influence the prognosis negatively. In our experience, the prognosis of hydrocephalus operated on in the first month of life does not differ from that of hydrocephalus operated on late in life.
Asunto(s)
Hidrocefalia/etiología , Hidrocefalia/cirugía , Derivaciones del Líquido Cefalorraquídeo , Estudios de Seguimiento , Humanos , Hidrocefalia/complicaciones , Recién Nacido , Desempeño Psicomotor , Resultado del TratamientoRESUMEN
The introduction of new diagnostic tools for neuroimaging has resulted in the early recognition of congenital brain tumors. In the present report the authors describe an International Multicenter Series of 886 children with brain tumor, in whom the diagnosis was obtained during the first 12 months of life. Most of the tumors were located within the supratentorial compartment. In spite of a relatively high operative mortality, surgery still appears to be the more effective therapy. Radiotherapy in this age group is of little value due to the vulnerability of the infantile brain. At the present time, the use of chemotherapy is still controversial.
Asunto(s)
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/congénito , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/terapia , Terapia Combinada , Diagnóstico por Imagen , Femenino , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Tasa de Supervivencia , Tomografía Computarizada por Rayos XRESUMEN
Congenital dermal sinus represents a dysraphic state of the central nervous system. It can show up throughout a defect of the midline, of both the skull and the spine. Usually, the malformation presents a fistulous tract, connecting the skin with the underlying tissues (hypoderm, paraspinal muscles, vertebrae and, in some cases, also the dura mater and spinal cord). The incidence of the malformation is quite low, 1:2,500 births; the cervical and dorsal locations represent the less common region. The malformation can remain undetected at the clinical examination because of the scarce cutaneous stigmata. Usually, it is revealed by repeated episodes of meningeal infection, due to the free communication between the inner dural space and the nervous structure and the external space, allowed by the open cutaneous tract. The case of a cervical dermal sinus tract, observed and successfully treated in a 10-months-old female child prompted us to this study and to review of the cases reported in the literature.
Asunto(s)
Espina Bífida Oculta/diagnóstico , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Espina Bífida Oculta/patología , Espina Bífida Oculta/cirugía , Columna Vertebral/patologíaRESUMEN
The introduction of the new diagnostic tools for neuroimaging has resulted in the early recognition of congenital brain tumors. In the present report we describe 39 children, in whom the diagnosis of an intracranial tumor has been obtained during the first 12 months of life. These patients represent 14.4% of a pediatric population of 271 children with brain tumors, observed in the same period of time (11 years) in the Neurosurgical Institute of the Catholic University of Rome. Most of the tumors were located within the supratentorial compartment. Midline tumors were common. Sixteen children underwent the total removal of the tumor. Four infants could not be operated either because their poor general condition or the extension of the tumor. In one case, treatment was refused by the parents. The remaining children underwent the partial removal of the tumor, which was followed by chemotherapy (malignant tumors) or by serial neuroradiological examination (benign tumors), with the aim of postponing radiotherapy at the end of 2 years of age at least. The total mortality (surgical deaths: 7 cases) and deaths during the follow-up period (11 cases) was 38.5%. Out of the 24 surviving children, 8 (20%) are normal: 7 (17%) exhibit only minimal neurosurgical deficits; 9 (22%) are seriously handicapped. One child has been lost for the follow-up observation.
Asunto(s)
Neoplasias Encefálicas/epidemiología , Factores de Edad , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Femenino , Humanos , Lactante , Recién Nacido , Italia/epidemiología , Masculino , Tomografía Computarizada por Rayos XRESUMEN
The introduction of new diagnostic tools for neuroimaging has resulted in the early recognition of congenital brain tumors. In the present report we describe a personal series of 39 children and an International Multicenter Series of 876 children with brain tumors, in whom the diagnosis was obtained during the first 12 months of life. Most of the tumors were located within the supratentorial compartment. In spite of a relatively high operative mortality, surgery still appears to be the more effective therapy. Radiotherapy in this age group is of a scarce value, due to the vulnerability of the infantile brain. At the present time, chemotherapy still plays a controversial role.
Asunto(s)
Neoplasias Encefálicas , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Masculino , Pronóstico , Factores SexualesRESUMEN
One hundred-sixty-one cases of children operated on for craniostenosis in the first year of life at the Neurosurgical Department of the Catholic University of Rome in the period 1982-1986 are presented. The average age at diagnosis was 6 months and at operation 7.4 months. The patients considered in the present study were subdivided into two groups according to the prevalent involvement of sagittal suture or of the anterior sutural group (coronal metopic, spheno-frontal and spheno-palatine sutures). In fact, these two groups differ considerably not only in the characteristics of the pathological process of early fusion of the cranial sutures, but also in the technique required for surgical correction. Four children with premature fusion of all cranial sutures are considered separately. Congenital malformations of the bone structures or changes in ocular motility were presented in 7.9% of 63 patients with sagittal craniostenosis and in 14.7% of the group with premature fusion of the anterior cranial sutures. Surgical correction (linear craniectomies extended to the cranial base for the group with sagittal craniostenosis, craniectomies with advancement of the supraorbital margin and rotation of the bone operculum for the group with anterior craniostenosis) proved satisfactory in the great majority of cases. Postoperative morbidity was particularly low. Apart from postsurgical anaemia which required blood transfusion on the third day in 15.5% of operated patients, the only complications were transitory hyperpyretic states observed in 6.2% of cases. Only one child died for reasons related to the surgical procedure. The low postoperative mortality (0.6% of cases) and the low percentage of bone pathology recurrence (7.4%) compared with the results of other series involving older children, seem to indicate that the early surgical correction of bone malformations does not bear additional risk for the patient, permitting at the same time normal functional development of the brain and a more gradual morphological remodelling of the skull.
Asunto(s)
Disostosis Craneofacial/cirugía , Craneosinostosis/cirugía , Craneosinostosis/diagnóstico por imagen , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Radiografía , RecurrenciaRESUMEN
The authors describe 32 children between 2 and 15 years of age who had hydrocephalus that was only clinically manifest late in life. The clinical picture of these children did not suggest an obvious increase in intracranial pressure; instead, the presenting signs were rather nonspecific and included macrocrania, mild psychomotor retardation, unsteady gait, increased muscle tone and deep tendon reflexes in the lower limbs, impaired ocular movement, epilepsy, and endocrine dysfunction. Their histories suggest the possible causes of the ventricular dilation in about one third of the cases were: perinatal hemorrhage, leptomeningitis, neurofibromatosis, and untreated aneurysm of the great vein of Galen. In 20 patients, however, no positive anamnestic findings were reported. CT scan revealed triventricular dilation in more than half of the cases; tetraventricular dilation was present in 6 patients, and biventricular dilation in the remaining subjects. All children underwent CSF shunting, which resulted in complete recovery in all but 2 cases. The most frequently recorded surgical complication was post-operative subdural effusion (7 subjects), which required surgical treatment in only 2 cases.
Asunto(s)
Hidrocefalia/diagnóstico , Presión Intracraneal , Adolescente , Derivaciones del Líquido Cefalorraquídeo , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Hidrocefalia/etiología , Hidrocefalia/cirugía , Imagen por Resonancia Magnética , Masculino , Complicaciones Posoperatorias/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
This report describes six cases of chronic alcoholics affected by Guillain-Barré syndrome. The syndrome was the main clinical feature recorded in the patients. The possibility that alcohol abuse may have relevance in the pathogenesis of the Guillain-Barré syndrome is discussed.