RESUMEN
ABSTRACT PURPOSE: To investigate whether topically administered hemostatic agents ankaferd blood stopper and microporous polysaccharide hemospheres can decrease epidural fibrosis after laminectomy in rats. METHODS: Eighteen adult male Sprague-Dawley rats were equally and randomly divided into three groups. In the treatment groups, ankaferd blood stopper and microporous polysaccharide hemospheres topically administrated upon duramater surface after laminectomy. Fibroblast count, epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that the count of fibroblasts, the grading of epidural fibrosis and arachnoideal involvement in the rats treated with microporous polysaccharide hemospheres were significantly less than the control group. Although the arachnoideal involvement in ankaferd blood stopper group were significantly less than the control group, there were no statistical differences when comparing the grading of epidural fibrosis and the fibroblasts count between the treatment groups and the control group. CONCLUSION: The ankaferd blood stopper and microporous polysaccharide hemospheres reduced epidural fibrosis and arachnoideal involvement after laminectomy in rats.
Asunto(s)
Animales , Masculino , Espacio Epidural , Hemostáticos/administración & dosificación , Extractos Vegetales/administración & dosificación , Polisacáridos/administración & dosificación , Complicaciones Posoperatorias/patología , Administración Tópica , Aracnoides/patología , Fibroblastos/patología , Fibrosis/patología , Fibrosis/prevención & control , Laminectomía/efectos adversos , Modelos Animales , Distribución Aleatoria , Ratas Sprague-DawleyRESUMEN
BACKGROUND: Primary empty sella is a herniation of the sellar diaphragm into the pituitary space. It is an incidental finding and patients may manifest neurological, ophthalmological and/or endocrine disorders. Episodes of vertigo, dizziness, and hearing loss, have been reported. OBJECTIVE: To determine the conditional probability, as well as the statistical dependency, through the Bayesian analysis in patients with primary empty sella and audiovestibular disorders. PATIENTS: Individuals who attended the National Rehabilitation Institute from January 2010 to December 2011, diagnosed with primary empty sella and audiovestibular disorders. MATERIAL AND METHODS: An analysis was performed on a sample of 18 patients with a diagnosis of primary empty sella confirmed with magnetic resonance studies and who had signs of vertigo, hearing loss and dizziness. RESULTS: Of the 18 patients studied, 3 (16.66%) had primary empty sella as the only clinical evidence. In 9 patients (50%) empty sella was associated with vertigo, and 16 patients (88.88%) were diagnosed with hearing loss, with sensorineural hearing loss being the most frequent (77.77%). The intersection between the proportions of primary empty sella with the presence and type of hearing loss was calculated. Thus for sensorineural hearing loss, the calculated ratio was P(AB)=0.6912, and for conductive and mixed hearing loss the value of P(AB)=0.0493 in both cases. CONCLUSIONS: Bayesian analysis and conditional probability enables the dependence between two or more variables to be calculated. In this study both mathematical models were used to analyse comorbidities and audiovestibular disorders in patients diagnosed with primary empty sella.
Asunto(s)
Síndrome de Silla Turca Vacía/epidemiología , Pérdida Auditiva/epidemiología , Vértigo/epidemiología , Adulto , Anciano , Aracnoides/patología , Teorema de Bayes , Comorbilidad , Estudios Transversales , Diplopía/epidemiología , Diplopía/etiología , Síndrome de Silla Turca Vacía/patología , Enfermedades del Sistema Endocrino/epidemiología , Enfermedades del Sistema Endocrino/etiología , Femenino , Cefalea/epidemiología , Cefalea/etiología , Humanos , Hipertensión/epidemiología , Hipopituitarismo/epidemiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Sobrepeso/epidemiología , Hipófisis/patología , MuestreoRESUMEN
PURPOSE: To investigate whether topically administered hemostatic agents ankaferd blood stopper and microporous polysaccharide hemospheres can decrease epidural fibrosis after laminectomy in rats. METHODS: Eighteen adult male Sprague-Dawley rats were equally and randomly divided into three groups. In the treatment groups, ankaferd blood stopper and microporous polysaccharide hemospheres topically administrated upon duramater surface after laminectomy. Fibroblast count, epidural fibrosis and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Our data revealed that the count of fibroblasts, the grading of epidural fibrosis and arachnoideal involvement in the rats treated with microporous polysaccharide hemospheres were significantly less than the control group. Although the arachnoideal involvement in ankaferd blood stopper group were significantly less than the control group, there were no statistical differences when comparing the grading of epidural fibrosis and the fibroblasts count between the treatment groups and the control group. CONCLUSION: The ankaferd blood stopper and microporous polysaccharide hemospheres reduced epidural fibrosis and arachnoideal involvement after laminectomy in rats.
Asunto(s)
Espacio Epidural , Hemostáticos/administración & dosificación , Extractos Vegetales/administración & dosificación , Polisacáridos/administración & dosificación , Complicaciones Posoperatorias/patología , Administración Tópica , Animales , Aracnoides/patología , Fibroblastos/patología , Fibrosis/patología , Fibrosis/prevención & control , Laminectomía/efectos adversos , Masculino , Modelos Animales , Distribución Aleatoria , Ratas Sprague-DawleyRESUMEN
BACKGROUND: Management of communicating hydrocephalus associated with infectious meningitis and arachnoiditis of the basal cisterns can be challenging if no microorganism or pathological diagnosis is established. The purpose of our series is to elucidate the efficacy of endoscopic basal cistern exploration, biopsy, and endoscopic third ventriculostomy (ETV) in patients with basal cistern meningitis and hydrocephalus. METHODS: Between 2005 and 2010, all patients who underwent transventricular endoscopic exploration biopsy and biopsy of the basal cisterns were analyzed and prospectively followed up. Particular attention was given to neuroendoscopic findings, sensitivity of biopsy, and the role of ETV. RESULTS: Twenty-four patients, ranging in age from 2 to 63 years, underwent transventricular endoscopic biopsy and exploration of the basal cisterns. All patients had negative cerebrospinal fluid analysis obtained by lumbar puncture. Successful ETV, exploration, dissection, and biopsy of the basal cisterns were performed successfully in all patients with a flexible neuroendoscope. Neuroendoscopic findings included: unusually thick Liliequist membrane, moderate to severe adhesive arachnoiditis, inflammatory and cotton-like exudates, granulations, and narrow subarachnoid space. Definitive histopathological diagnosis from the basal cisterns specimen was obtained in 79% of patients. There were no complications related to the procedure. At 15 months of follow-up, 70% of the patients with hydrocephalus did not require a ventriculoperitoneal shunt. CONCLUSIONS: Endoscopic transventricular basal cisterns exploration is feasible with a flexible neuroendoscope. It is a viable alternative in the management of patients with basal cistern meningitis and arachnoiditis without histopathological diagnosis. It yields to an accurate diagnosis in 79% of the patients. ETV is a good alternative in the management of intracisternal extraventricular obstructive hydrocephalus.
Asunto(s)
Ventrículos Cerebrales/cirugía , Hidrocefalia/patología , Hidrocefalia/cirugía , Meningitis/patología , Meningitis/cirugía , Neuroendoscopía/métodos , Adolescente , Adulto , Anciano , Anestesia General , Aracnoides/patología , Aracnoiditis/cirugía , Biopsia , Corteza Cerebral/patología , Corteza Cerebral/cirugía , Líquido Cefalorraquídeo/química , Líquido Cefalorraquídeo/citología , Niño , Preescolar , Estudios de Cohortes , Duramadre/patología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Meningitis/complicaciones , Trastornos Mentales/etiología , Trastornos Mentales/psicología , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Gliomas are the most common infiltrative neoplasms of the optic nerve and can present as two distinct growth patterns: intraneural glial proliferation and perineural arachnoidal gliomatosis (PAG). It has been suggested that perineural arachnoidal gliomatosis is seen almost exclusively in the setting of neurofibromatosis type 1 (NF1). We describe a child with perineural arachnoidal gliomatosis occurring without neurofibromatosis type 1, supported by both radiographic and histological findings. A 4-year-old female without neurofibromatosis type 1 presented with rapidly progressive right-sided proptosis. Magnetic resonance imaging (MRI) revealed an enhancing fusiform intraconal lesion, which was hypointense on T1 and hyperintense on T2-weighted images: characteristic of perineural arachnoidal gliomatosis, the optic nerve was visualized coursing the tumor. Histopathologic study was consistent with perineural arachnoidal gliomatosis. Perineural arachnoidal gliomatosis can develop independent of neurofibromatosis type 1, as demonstrated by this case.
Asunto(s)
Aracnoides/patología , Neurofibromatosis 1/patología , Glioma del Nervio Óptico/patología , Aracnoides/diagnóstico por imagen , Biopsia , Preescolar , Femenino , Humanos , Imagen por Resonancia Magnética , Neurofibromatosis 1/diagnóstico por imagen , Glioma del Nervio Óptico/diagnóstico por imagen , RadiografíaRESUMEN
Gliomas are the most common infiltrative neoplasms of the optic nerve and can present as two distinct growth patterns: intraneural glial proliferation and perineural arachnoidal gliomatosis (PAG). It has been suggested that perineural arachnoidal gliomatosis is seen almost exclusively in the setting of neurofibromatosis type 1 (NF1). We describe a child with perineural arachnoidal gliomatosis occurring without neurofibromatosis type 1, supported by both radiographic and histological findings. A 4-year-old female without neurofibromatosis type 1 presented with rapidly progressive right-sided proptosis. Magnetic resonance imaging (MRI) revealed an enhancing fusiform intraconal lesion, which was hypointense on T1 and hyperintense on T2-weighted images: characteristic of perineural arachnoidal gliomatosis, the optic nerve was visualized coursing the tumor. Histopathologic study was consistent with perineural arachnoidal gliomatosis. Perineural arachnoidal gliomatosis can develop independent of neurofibromatosis type 1, as demonstrated by this case.
Gliomas são as neoplasias infiltrativas mais freqüentes do nervo óptico e podem se apresentar através de dois padrões distintos de crescimento: proliferação glial intraneural e gliomatose aracnoidal perineural. Existem evidências de que a gliomatose aracnoidal perineural é vista quase exclusivamente em pacientes com neurofibromatose tipo 1. Descrevemos um caso de gliomatose aracnoidal perineural ocorrendo em criança sem neurofibromatose tipo 1, comprovado tanto por achados radiológicos quanto histológicos. Uma criança de quatro anos de idade, do sexo feminino, sem evidências de neurofibromatose tipo 1, apresentou quadro de proptose à direita rapidamente progressiva. Ressonância magnética revelou lesão intraconal fusiforme hipointensa em T1 e hiperintensa em T2 - característico de gliomatose aracnoidal perineural, o nervo óptico pôde ser observado atravessando o tumor. O estudo histológico foi consistente com gliomatose aracnoidal perineural. Gliomatose aracnoidal perineural pode se desenvolver independente da presença de neurofibromatose tipo 1, como demonstrado por esse caso.
Asunto(s)
Preescolar , Femenino , Humanos , Aracnoides/patología , Neurofibromatosis 1/patología , Glioma del Nervio Óptico/patología , Aracnoides , Biopsia , Imagen por Resonancia Magnética , Neurofibromatosis 1 , Glioma del Nervio ÓpticoRESUMEN
BACKGROUND: There are few reports on the outcome of surgical treatment of TGN without vascular compression. METHODS: Between 1984 and 2004, 668 patients underwent MVD for TGN. In 21 patients (3.1%), vascular compression was absent. The surgical strategy in these cases involved the following: (1) dissection and exposure of the entire trigeminal nerve root; (2) slight neurapraxia with bipolar tips at the trigeminal nerve root; and (3) isolation of trigeminal nerve with Teflon sponge fragments. RESULTS: The patients' (female/male, 20:1) ages ranged from 33 to 77 years. Their right side was the most frequently involved (61.9%). Their mean duration of pain before treatment was 7.6 years (range = 1-20 years). At surgical exploration, vascular compression or anatomical abnormalities were absent in 15 patients (71.4%), arachnoidal thickening was present in 5 (23.8%), and fiber dissociation of the trigeminal nerve was present in 1 (4.8%). Mean follow-up after surgery was 17.7 months (range = 4-65 months). Immediate relief from pain occurred in all 21 patients. On Kaplan-Meier analysis, recurrence was maintained at 14.8% for 12, 24, and 36 months, increasing to 43.2% at 48 months. Permanent hypoesthesia was present in 6 patients (28.6%), whereas loss of corneal reflex was observed transiently in 1 (4.8%). Motor function of the trigeminal nerve was intact in all patients. No other complication was found. CONCLUSION: The proposed surgical plan of standard MVD plus slight trigeminal nerve root neurapraxia is a safe and effective management option for TGN without vascular compression.
Asunto(s)
Descompresión Quirúrgica/métodos , Procedimientos Neuroquirúrgicos/métodos , Nervio Trigémino/cirugía , Neuralgia del Trigémino/cirugía , Adulto , Anciano , Aracnoides/patología , Aracnoides/fisiopatología , Arteria Basilar/patología , Arteria Basilar/fisiopatología , Fosa Craneal Media/anatomía & histología , Fosa Craneal Media/patología , Fosa Craneal Media/cirugía , Descompresión Quirúrgica/instrumentación , Descompresión Quirúrgica/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Estudios Prospectivos , Resultado del Tratamiento , Nervio Trigémino/patología , Nervio Trigémino/fisiopatología , Neuralgia del Trigémino/etiología , Neuralgia del Trigémino/fisiopatología , Insuficiencia Vertebrobasilar/complicaciones , Insuficiencia Vertebrobasilar/patología , Insuficiencia Vertebrobasilar/fisiopatologíaRESUMEN
Thoracic spine arachnoid ossification is a relatively rare disease that affects mainly women and causes sensory, motor, and sphinctal symptoms associated with inferior limb pain. Based on three cases, the authors comment on pathogenic and surgery-related aspects of the disease. The patient in Case 1 was followed over the course of 23 years. Spinal cavitation is highlighted in Case 2, and yellow, gross, half-ring ossification is described in Case 3. Calcium deposits usually occur in the middle and lower thoracic spine where the majority of trabeculated arachnoid cells are located. Operative treatment does not interrupt the ossification process, which continues over time, causing progressive deterioration in the patient. Spinal cavitation can occur due to spinal cord tethering, stretching, and central cord edema formation, accompanied by cerebrospinal fluid blockage and pulse pressure changes. The results of surgical intervention are poor, offering short-term recovery with later deterioration. Multiple pathogenic factors are involved in this clinical syndrome including metabolic changes.
Asunto(s)
Aracnoides , Enfermedades del Sistema Nervioso Central/complicaciones , Osificación Heterotópica/complicaciones , Enfermedades de la Médula Espinal/etiología , Vértebras Torácicas , Adulto , Aracnoides/patología , Aracnoides/cirugía , Enfermedades del Sistema Nervioso Central/diagnóstico , Enfermedades del Sistema Nervioso Central/cirugía , Femenino , Humanos , Espectroscopía de Resonancia Magnética , Persona de Mediana Edad , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/cirugía , Reoperación , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/cirugía , Vértebras Torácicas/patología , Vértebras Torácicas/cirugíaAsunto(s)
Aracnoides/patología , Linfoma no Hodgkin/diagnóstico , Neoplasias Meníngeas/diagnóstico , Neoplasias Primarias Secundarias/diagnóstico , Piamadre/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Niño , Preescolar , Irradiación Craneana , Femenino , Estudios de Seguimiento , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Masculino , Neoplasias Meníngeas/tratamiento farmacológico , Neoplasias Meníngeas/radioterapia , Neoplasias Primarias Secundarias/tratamiento farmacológico , Neoplasias Primarias Secundarias/radioterapia , Inducción de Remisión , Columna Vertebral/efectos de la radiaciónRESUMEN
The use of polymerase chain reaction (PCR) for routine detection of clonal immunoglobulin heavy-chain (IgH) gene rearrangements represents an attractive alternative to Southern hybridization analysis not only because PCR protocols are quicker and simpler, but also because of the ability to analyze very small population of cells in search of minimal residual disease. This can be especially important for the detection of clonal malignant cells in locations other than bone marrow or peripheral blood. We describe a case in which central nervous system involvement, a very rare complication of chronic lymphocytic leukemia, was confirmed by PCR analysis for IgH genes rearrangement of the lymphocytes found in cerebrospinal fluid. The cerebrospinal fluid and the peripheral blood lymphocytes (obtained from archival cytospins stored at the time of diagnosis, 5 years before) presented an identical IgH gene rearrangement, as shown by sequence analysis. Thus, the use of PCR for IgH genes rearrangement can be very useful in the detection of monoclonality in samples with a small number of cells and in the confirmation of the common origin of B cells in different specimens of the same patient.
Asunto(s)
Aracnoides/patología , Leucemia Linfocítica Crónica de Células B/líquido cefalorraquídeo , Linfocitos/citología , Reacción en Cadena de la Polimerasa/métodos , Líquido Cefalorraquídeo/citología , ADN/aislamiento & purificación , Humanos , Leucemia Linfocítica Crónica de Células B/genética , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Se analiza la correlación transoperatoria de lactancia y amplitud del componente positivo principal de potenciales evocados visuales y la variación del cuadro oftalmológico preoperatorio y posoperatorio (agudeza visual, campo visual y potenciales evocados visuales a patrón), en 14 pacientes con adenomas hipofisiarios y aracnoidoceles intervenidos quirúrgicamente por vía transesfenoidal en el Hospital Clinicoquirúrgico "Hermanos Ameijeiras" . Se comprobó que el aumento de amplitud transoperatoria es tá asociada a un mejor pronóstico oftalmológico
Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Potenciales Evocados Visuales , Campos Visuales , Adenoma/cirugía , Neoplasias Hipofisarias/cirugía , Neoplasias Meníngeas/cirugía , Aracnoides/patología , Cuidados IntraoperatoriosRESUMEN
Se analiza la correlación transoperatoria de lactancia y amplitud del componente positivo principal de potenciales evocados visuales y la variación del cuadro oftalmológico preoperatorio y posoperatorio (agudeza visual, campo visual y potenciales evocados visuales a patrón), en 14 pacientes con adenomas hipofisiarios y aracnoidoceles intervenidos quirúrgicamente por vía transesfenoidal en el Hospital Clinicoquirúrgico "Hermanos Ameijeiras" . Se comprobó que el aumento de amplitud transoperatoria es tá asociada a un mejor pronóstico oftalmológico
Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Adenoma/cirugía , Potenciales Evocados Visuales , Neoplasias Meníngeas/cirugía , Neoplasias Hipofisarias/cirugía , Campos Visuales , Aracnoides/patología , Cuidados Intraoperatorios , Procedimientos Quirúrgicos OperativosRESUMEN
The purpose of this study was to investigate using light microscopy the fibrocellular components of arachnoid granulations affected by mild and severe subarachnoid hemorrhage. The erythrocytes were in the channels delimited by collagenous and elastic bundles and arachnoid cells, showing their tortuous and inter-communicating row from the pedicle to the fibrous capsule. The core portion of the pedicle and the center represented a principal route to the bulk outflow of cerebrospinal fluid and erythrocytes. In the severe hemorrhage, the fibrocellular components are disorganized, increasing the extracellular channels. We could see arachnoid granulations without erythrocytes, which cells showed big round nucleus suggesting their transformation into phagocytic cells.
Asunto(s)
Aracnoides/patología , Tejido de Granulación/patología , Hemorragia Subaracnoidea/patología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Por microscopia óptica foram estudados os componentes fibrosos das granulaçöes aracnódes de indivíduos acometidos por hemorragia subaracnóide de tipo moderado ou severo. Os eritrócitos estavam presentes nos canais delimitados por feixes de fibras elásticas, colágenas e células aracnóides. Os canais tortuosos e intercomunicantes eram observados desde o pediculo até a cápsula fibrosa da granulaçäo aracnóide. O principal trajeto dos eritrócitos e do líquido cáfalo-raquidiano ocorria no interior do pedículo e centro da granulaçäo aracnóide. Na hemorragia severa, os compoentes fibro-musculares estavam desorganizados e os canais extra-celulares aumentados. A presença de células com grandes núcleos, observada no material hemorrágico, é sugestiva de transformaçöes das células aracnóides em células fagocitárias, para promover a digestäo intracelular dos eritrócitos
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Aracnoides/patología , Hemorragia Subaracnoidea/complicaciones , Tejido de Granulación/patología , Hemorragia Subaracnoidea/patologíaRESUMEN
BACKGROUND: Nodules of cells showing a striking histological similarity to those of arachnoid villi have previously been found closely adjacent to pulmonary venules in several diseases associated with alveolar hypoxia or pulmonary oedema including mitral stenosis, plexogenic pulmonary arteriopathy, pulmonary thromboembolism, and chronic obstructive pulmonary disease. METHODS: Histological sections of the lungs of seven adult native highlanders from La Paz (3600 m) were examined. RESULTS: Arachnoid nodules were found in the lungs of one Aymara and one Mestizo Indian. CONCLUSIONS: These bodies may have a similar function to that of arachnoid granulations which transfer excess cerebrospinal fluid to the dural venous sinuses. In the native highlanders it is possible that they contribute to the avoidance of excessive hydration of the interstitial tissue of the alveolar walls with return of fluid into the pulmonary venules, preventing incipient pulmonary oedema.
Asunto(s)
Altitud , Indígenas Sudamericanos , Pulmón/patología , Adolescente , Adulto , Aracnoides/patología , Bolivia , Femenino , Humanos , Masculino , Arteria Pulmonar/patologíaRESUMEN
Se presentó un caso de meningitis recurrente con antecedentes de trauma craneano. Se deduce que la vía de infección fue orofaringe vía trompa de Eustaquio. Los estudios tomográficos demuestran quiste aracnoideo que se insinúa en la fractura del peñasco. Se repara la zona de fractura, se extirpa el quiste, se reconstruye la duramadre. La evolución fue altamente satisfactoria, con seguimiento asintomático de 17 meses