2,167 research outputs found
Seizure suppression after left anterior temporal lobectomy in a patient with an ipsilateral parietal lesion
No full textEpilepsy surgery can provide a solution
for drug-resistant patients (Revlyn, 2003).
Non-lesional epilepsies account for
20–30% of patients in major epilepsy
surgery centres (Cascino, 2001)
The role of preoperative angiography in the management of giant meningiomas associated to vascular malformation
No full textBackground: The role of preoperative digital subtraction angiography (DSA) in meningiomas is currently under discussion because of the introduction of noninvasive magnetic resonance imaging (MRI) angiography to study vascular anatomy associated to the tumor. Preoperative DSA is mainly performed to obtain embolization of the lesion, although a number of complications have been reported after this procedure. Nonetheless, the coexistence of meningiomas with vascular malformations has previously been reported and it has been evidenced that this event could be underestimated because of neglect of preoperative DSA. Here, we report on two challenging cases of giant meningiomas associated to vascular malformations and we discuss the pertinent literature. Case Descriptions: In the first case: A large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit - a large pseudoaneurysm of right middle cerebral artery branch was found end embolized during DSA. In the second case: A giant parieto-temporal meningioma - DSA permitted the full visualization of an abnormal drainage of superior sagittal sinus like a "sinus pericranii" that was respected during the following surgery. Conclusion: We think that MRI angiography is the exam of choice to study vascular anatomy in meningiomas. Nonetheless, DSA remains a useful tool in giant meningiomas not only to embolizate the lesion but also to treat tumor associated vascular malformation and to achieve the full knowledge of vascular anatomy. We think that a wide communication between interventionalist and surgeon is essential for the optimal management of these patients
Advances in diagnosis and treatment of trigeminal neuralgia
No full textNicola Montano,1 Giulio Conforti,1 Rina Di Bonaventura,1 Mario Meglio,2 Eduardo Fernandez,1 Fabio Papacci1 1Institute of Neurosurgery, Catholic University, Rome, 2Institute of Neurosurgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy Abstract: Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN). Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression) and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures) have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that neurostimulation might represent an opportunity in TN refractory to other surgical treatments. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, and medical and surgical treatments, and discuss the significant advances in all these fields. Keywords: microvascular decompression, percutaneous balloon compression, gamma knife radiosurgery, surgical treatment, magnetic resonance imaging, therap
Anterior cervical discectomy and interbody fusion with porous tantalum implant. Results in a series with long-term follow-up
No full textFew papers have been published about the anterior cervical discectomy and fusion (ACDF) with implant of porous tantalum cages. These studies included patients submitted to operation at a single level. To our knowledge, we report the results of the largest series of ACDF with implant of porous tantalum cages. Our series included patients operated at a single or double level with a long follow-up (FU). We also discuss the pertinent literature. Clinical and outcome data of 99 consecutive patients (47 men, 52 women) submitted to ACDF with implant of porous tantalum cages (Trabecular Metal TM-S Cervical Fusion Device, Zimmer Spine, Minneapolis, MN) from June 2007 to September 2012, were retrospectively reviewed. Mean FU was 67.47±19.63months. The changes in pain were assessed using the Visual Analogue Scale (VAS). Patients were evaluated pre-operatively and at FU with the Short Form-36 Score Health Survey Version 2.0 (SF-36v2) for Physical Health and Mental Health Scores and the Neck Disability Index. We globally found a statistically significant improvement of all evaluated scores. Patients operated at two levels experienced a statistically significant improvement of all scores, with no statistical difference compared to patients operated at one level. No major complications occurred post-operatively and at FU. Only one patient (operated at two level) experienced an infection during FU. We conclude that ACDF with porous tantalum cages is a safe procedure, with long term clinical benefits (also in patients operated at two levels) and a very low rate of complications
Totally intra-axial giant spinal schwannoma with late clinical onset
No full textA 44-year-old woman was hospitalized for a 2-month history of progressive spastic paraparesis and low back pain. A magnetic resonance imaging study showed a T7–L1 giant intradural extramedullary mass with total intra-axial development, causing vertebral bone scalloping with left dislocation of the spinal cord (FigureA–B). At surgery, after exposure of the T6–L3 segments, laminar bone erosion was evident. A T7–L2 laminectomy and dura mater opening were then performed, identifying the upper and lower poles of the tumor. The mass was gently dissected from spinal cord and cauda equina roots and then removed en bloc (Figure C). Histopathological examination documented a schwannoma. The postoperative course was uneventful. By 6-months postsurgery, the patient was able to walk without support and returned to her previous occupation. A postoperative magnetic resonance imaging scan documented complete removal of the lesion (Figure D). Only one other case of a giant spinal schwannoma (defined as a schwannoma extending greater than two vertebral levels [1]) with minimal neurological deficit has been reported [2]
The use of TachoSil® associated to fibrin glue as dural sealant in spinal intradural tumors surgery
No full textN/
Diagnostic yield and predictive value of provoked ictal SPECT in drug-resistant epilepsies
No full textBrain single photon emission computed tomography (SPECT) can be a useful tool to identify the epileptogenic zone in selected patients. However, ictal SPECT during spontaneous seizures is difficult to obtain and can be expensive, due to extra hospitalization time and personnel resource utilization. The efficacy of ictal SPECT depends on the ability to inject as early as possible after the beginning of the ictal discharge and/or the occurrence of the first symptom and is challenged by the short duration and rapid propagation of seizures, especially extratemporal seizures. We studied 52 patients with drug-resistant epilepsy who underwent ictal SPECT during provoked seizures in order to demonstrate the efficacy of this technique to define the epileptogenic zone and its predictive value on surgical outcome 2 and 5 years after surgery. In our study, SPECT hyperperfusion areas and electroclinical findings co-localized within the same lobe in 40 patients. Thirty-one patients were operated; at the 2-year follow-up 25 of these patients were in Engel's class I. Eighteen of the seizure-free patients showed a co-localization between the provoked SPECT hyperperfusion areas and the epileptogenic zones. Eighteen of the 31 operated patients were followed 5 years after surgery. The surgical outcome was stable in all but one subject. All the patients who were seizure-free at the 5-year follow-up showed a co-localization between the provoked SPECT hyperperfusion areas and the epileptogenic zones. Ictal SPECT demonstrated additional diagnostic value in the identification of the epileptogenic zone in 20 patients: 11 extratemporal (4 probably symptomatic and 7 lesional), 1 temporal plus (probably symptomatic), and 8 temporal (1 probably symptomatic and 7 lesional). Statistical analysis showed a significant association between the concordance of SPECT hyperperfusion areas to epileptogenic zones and freedom from seizures as assessed 5 years after surgery
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