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Anatomical relationships between the V2 segment of the vertebral artery and the cervical nerve roots.
No full text
From congenital to idiopathic adult hydrocephalus: A historical research
No full textReports of idiopathic adult hydrocephalus prior to the 1965 description of idiopathic normal pressure hydrocephalus by Salomón Hakim and Raymond Adams are lacking in the literature. Congenital paediatric and congenital adult hydrocephalus were considered to trace the early descriptions of idiopathic adult hydrocephalus. Through traditional or digital libraries and internet search engines, the historical sources dealing with idiopathic adult hydrocephalus were explored. The research shows that many distinguished physicians through the centuries have contributed to the discovery of idiopathic adult hydrocephalus. Early descriptions of the disorder were related to autopsy studies in the 18th and 19th centuries. From the second half of the 1800s, idiopathic adult hydrocephalus appeared to have been forgotten in the medical literature. © The Author (2010)
Disturbi del circolo liquorale
No full textIl liquido cerebrospinale o “ liquor” permea
tutto lo spazio subaracnoideo, colmando il
vuoto esistente tra il nevrasse e le meningi. La
funzione principale del liquor è quella di dissipare
energia e fornire protezione alle strutture
intracraniche in occasione di brusche accelerazioni,
come ad esempio nei traumi cranici.
Oltre a funzioni meccaniche, il liquor svolge
funzioni trofiche e immunologiche (vedi anche
capitolo sulla Diagnostica liquorale).
Il liquor è prodotto incessantemente (tra
400 e 500 ml ogni 24 ore) dai plessi corioidei
contenuti all’interno dei ventricoli. Considerando
che il contenuto totale di liquor è, tra
spazio intracranico e spazio spinale, di circa
140 ml, appare evidente che questo volume
può essere mantenuto solo grazie a un processo
di continuo riassorbimento liquorale.
Quest’ultimo si realizza a livello della convessità
cranica, in corrispondenza di alcune strutture
specializzate incluse nello spessore della
dura madre e note come granulazioni o villi
aracnoidali. Attraverso un processo di filtrazione
complesso e non ancora del tutto chiaro,
i villi aracnoidali convogliano il liquor assorbito
nelle vene proprie della dura madre e, in
ultima analisi, nel seno longitudinale superiore.
Esiste, pertanto, una correlazione tra
pressione venosa centrale, volume liquorale e
pressione intracranica.
Il “circolo liquorale” è il percorso che il
liquor compie dalla sede di produzione a
quella di riassorbimento. Schematizzando, il
liquor prodotto a livello di un ventricolo laterale
raggiunge il 3° ventricolo attraversando il
rispettivo forame di Monro, quindi il 4° ventricolo
attraverso l’acquedotto di Silvio, gli spazi
subaracnoidei basali attraversando i forami di
Luschka e Magendie; percorre diffusamente
gli spazi subaracnoidei della convessità e raggiunge le granulazioni aracnoidali. Parte del
liquor è dislocato nel canale spinale a livello
perimidollare; il travaso di liquor dal compartimento
intracranico a quello spinale è uno
dei primi e più efficaci sistemi messi in atto
dall’organismo per contenere aumenti della
pressione intracranica
Intraspinous postlaminectomy pseudomeningocele
No full textPseudomeningoceles are uncommon complications of lumbar surgery. They are encapsulated cerebrospinal fluid collections developing extradurally as a consequence of incidental dural tears. They are typically located in the paraspinal compartment and occasionally reach the subcutaneous space. We describe the case of a patient in whom a postlaminectomy pseudomeningocele developed over a 10-year period within the L5 spinous process and remained completely encircled within its bony boundaries. The surgical implications of this finding are discussed
Resection of a left insular cavernoma aided by a simple navigational tool. Technical note
No full textDeep brain stimulation (DBS) of the subthalamic nucleus (STN) is viewed by many as the ultimate therapy targeting severe advanced stages of Parkinson's disease (PD). A fundamental constituent of the mechanisms underlying the therapeutic effects of DBS is clearly the functional organization of the STN; however, there is limited understanding of the organization of this structure in humans. Data from primates suggest that different domains can be identified in the STN, including a sensorimotor area with a segregated body map, as well as nonmotor areas. Recent clinical studies have used microelectrode recording to investigate the presence of a body map in the sensorimotor STN of PD patients. This paper will review and compare experimental and clinical data regarding the functional organization of the STN and discuss the clinical implications for PD patients undergoing STN DBS
Combined intra-extracanal approach to lumbosacral disc herniations with bi-radicular involvement. Technical considerations from a surgical series of 15 cases.
No full textLarge lumbosacral disc herniations effacing both the paramedian and the foraminal area often cause double radicular compression. Surgical management of these lesions may be difficult. A traditional interlaminar approach usually brings into view only the paramedian portion of the intervertebral disc, unless the lateral bone removal is considerably increased. Conversely, the numerous far-lateral approaches proposed for removing foraminal or extraforaminal disc herniations would decompress the exiting nerve root only. Overall, these approaches share the drawback of controlling the neuroforamen on one side alone. A combined intra-extraforaminal exposure is a useful yet rarely reported approach. Over a 3-year period, 15 patients with bi-radicular symptoms due to large disc herniations of the lumbar spine underwent surgery through a combined intra-extracanal approach. A standard medial exposure with an almost complete hemilaminectomy of the upper vertebra was combined with an extraforaminal exposure, achieved by minimal drilling of the inferior facet joint, the lateral border of the pars interarticularis and the inferior margin of the superior transverse process. The herniated discs were removed using key maneuvers made feasible by working simultaneously on both operative windows. In all cases the disc herniation could be completely removed, thus decompressing both nerve roots. Radicular pain was fully relieved without procedure-related morbidity. The intra-extraforaminal exposure was particularly useful in identifying the extraforaminal nerve root early. Early identification was especially advantageous when periradicular scar tissue hid the nerve root from view, as it did in patients who had undergone previous surgery at the same site or had long-standing radicular symptoms. Controlling the foramen on both sides also reduced the risk of leaving residual disc fragments. A curved probe was used to push the disc material outside the foramen. In conclusion, specific surgical maneuvers made feasible by a simultaneous extraspinal and intraspinal exposure allow quick, safe and complete removal of lumbosacral disc herniations with paramedian and foraminal extension
Intraparenchymal haemorrhage after a cerebrospinal fluid tap-test for secondary normal pressure hydrocephalus
No full textThe lumbar tap test as a diagnostic and therapeutic procedure in idiopathic normal pressure hydrocephalus is used widely. Complications from lumbar punctures are rare. We report a man who underwent a tap-test for secondary normal pressure hydrocephalus, and after clinical improvement, suffered a fatal intraparenchymal brain haemorrhage three days later. © 2012 Elsevier Ltd. All rights reserved
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