1,720,995 research outputs found
Intracranial soft-tissue glomus tumor (glomangioma) in a young-woman. A case report and review of the literature
No full textI tumori glomici, o glomangiomi, sono tumori vascolari benigni in genere osservati alle estremità distali degli arti Questi tumori differiscono dai paragangliomi e sono presenti classicamente nella popolazione femminile tra il 4° e il 5° decennio. Localizzazioni intracraniche non sono state descritte in letteratura nella popolazione adulta. Viene qui presentato il caso di una donna di 32 anni con una storia di 3 mesi di progressiva perdita della vista a sinistra e mal di testa. Una risonanza magnetica preoperatoria ha mostrato una lesione omogenea che si estendeva dal seno cavernoso sinistro alla fossa cranica media inizialmente sospettata di essere un meningioma del seno cavernoso. Alla fine, l’analisi istopatologica si è conclusa per una diagnosi di glomangioma. È stata anche eseguita la RT post-operatoria. CONCLUSIONI: In base alla nostra esperienza, è molto importante per la gestione clinica considerare i glomangiomi nella diagnosi differenziale di una lesione extraassiale. La resezione subtotale seguita dalla radioterapia non ha determinato recidive della malattia fino a 7 anni.BACKGROUND: Glomus tumors, or glomangiomas, are benign vascular tumors typically seen at distal extremities. These tumors differ from paragangliomas and classically present in the female population between the 4th and 5th decade. Intracranial localizations have not been described in literature in the adult population. CASE DESCRIPTION: We present a case of a 32 year-old woman with a 3 months history of progressive left-sided visual loss and headache. A pre-operative MRI showed a homogeneously enhancing lesion extending from the left cavernous sinus to middle cranial fossa at first suspected to be a cavernous sinus meningioma. Eventually, histopathological analysis concluded for a glomangioma diagnosis. Post-operative RT was also performed. CONCLUSIONS: From our experience it is very important for clinical management considering glomangiomas in differential diagnosis of a homogeneously enhancing extra axial mass. Subtotal resection followed by radiation therapy determined no recurrence of the disease up to 7 years. KEY WORDS: Glomangioma, Glomus tumor, Soft-tissue tumor
Operative case of Langerhans'cell histiocytosis of the skull with dural invasion. An immunohystochemical study of ki-67 expression of eosinophilic granuloma: case report and review of the literature
No full textEosinophilic granuloma (EG), Letterer-Siwe disease and Hand-Schuller-Christian disease are collectively called Langherans-cell histiocytosis (LCH). While the latter two are systemic diseases, the former is a localized form of histiocytosis. Solitary EG of the skull are rare lesions characterized by a natural history not well defined yet. In this context, we report a case of a 23-year-old male suffering for a recurrent and progressive right parietal headache. On computed tomography (CT) it was observed an ostelytic lesion which on magnetic resonance imaging (MRI) appeared as an hyperintense soft mass on both T1 and T2 weighted images. The lesion showed a marked and heterogeneous enhancement after gadolinium administration. The surgical excision was complete and the severe headache disappeared. Immunohistochemical analysis of the specimen indicated an eosinophilic granuloma characterized by Ki-67 nuclear antigen expression with a labeling index of 20%. In the pertinent literature we have found two aggressive cases of EG showing the Ki-67 expression with a respectively 6.2% (occipital bone granuloma) and 10% (parietal bone granuloma) labeling index. That high proliferative activity suggests a local Langherans' cell proliferation along with an exuberant inflammatory response and also explains the aggressive clinical course and the rapid expansion of the lesion observed in some rare cases of solitary EG. This is the third case-report of calvarial EG characterized by Ki-67 nuclear antigen expression
Microsurgery for recurrent lumbar disk herniation at the same level and side: do patients fare worse? Experience with 95 consecutive cases.
No full textBACKGROUND: In reviewing our experience with reoperation of RLDH, our aim was mainly to determine whether patients fared worse than after primary surgery. We found no uniform answers to this question in the literature.
METHODS: The data of 95 patients (29 women and 66 men) who underwent reoperation for RLDH at the same level and side were analyzed retrospectively. Forty-two patients underwent the first operation in our clinic (recurrence rate, 2.6% of 1586 cases). Gadolinium-enhanced MRI was performed in all patients. Main clinical data of patients, pain-free interval, operation time, surgical complications, duration of hospital stay, and clinical improvement rate were recorded.
RESULTS: The mean pain-free interval was 55 months (range, 3-120 months). Levels of recurrent herniation were L4 through L5 and L5 through S1 (65% and 35% of cases, respectively). Revision surgery lasted longer on average than the previous diskectomy (P < .01) and was complicated by dural tear in 4 cases (4.2% vs 0.9% during primary diskectomy, P < .05). There were no significant differences between revision and previous surgery in terms of hospital stay. However, rates of excellent/good outcomes were significantly less for RLDH (89% vs 95%, P < .05); and the percentage of poor results was higher (2% vs 0.5%, P < .05). Age, sex, smoking, profession, trauma, level and degree of herniation, and pain-free interval were not correlated with clinical outcome.
CONCLUSION: Conventional microsurgery for RLDH showed lightly but significantly worse results than those of primary microdiskectomy. Patients contemplating reoperation should be informed of this fact and of the risk of dural tear and prolonged operation time
Anterior cervical discectomy without fusion: clinical long-term outcome in a series of 133 patients undegoing surgery 5 to 18 years earlier
No full textAscesso epidurale cervicale. Esperienza di trattamento microchirurgico in otto pazienti, compresi due casi di infezione mista tubercolare e piogenica
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Cervical Spine epidural abscess: experience with microsurgical treatment in eight cases.
No full textOBJECT: The authors report a series of eight consecutive cases in which epidural abscesses in the cervical spine were treated by microsurgery without arthrodesis, including two cases of concomitant pyogenic and tubercular infection.
METHODS: The authors used a minimally invasive surgical approach consisting of single-level anterior microsurgical discectomy and drainage of the epidural abscess via a silicone catheter, and then initiated antibiotic therapy. At follow-up examination (mean duration 39 months), six patients exhibited complete recovery and two suffered from minor residual deficits. In all cases, spontaneous vertebral fusion occurred. Sagittal alignment was maintained in seven patients, and in one there was slight asymptomatic kyphosis. In two patients, tubercular and pyogenic infections were found. Prior intervention for dental infection was recorded in four cases.
CONCLUSIONS: In the absence of preoperative spinal instability, microsurgical drainage of the abscess followed by specific antibiotic therapy resulted in spinal cord decompression and neurological recovery, thereby facilitating spontaneous fusion and vertebral stability. The presence of combined tubercular and pyogenic infections of the cervical spine should be considered, especially in patients whose immune systems are depressed
Preliminary results of a soft novel lumbar intervertebral prothesis (DIAM) in the degenerative spinal pathology.
No full textThe authors report a series of 43 patients suffering from lower limb pain, almost constantly associated with chronic or acute backpain, treated by microsurgical nerve root decompression and by implantation of a soft intervertebral prothesis (DIAM). Satisfying results were obtained in 97% of cases, inducing the authors to consider the device a reliable tool for curing low-back pain and sciatica. Selection criteria are exposed and discusse
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