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No full textBACKGROUND: Transoral surgery may be used to approach pathologies at the craniocervical junction. However, the need for this approach has decreased over the past few decades.OBJECTIVE: To assess the outcome and complications of transoral surgery and extended transoral approaches at a single UK center between 1980 and 2011.METHODS: A retrospective review was performed of 495 ventral midline operations (between 1980 and 2004) and prospective review of 38 operations (2004-2011) in a total of 479 patients. Trends in surgery and factors associated with good or bad outcome were assessed over this 30-year period.RESULTS: Of 533 operations, the most frequently performed surgeries were simple transoral surgery (321 operations), transoral surgery with splitting of the palate (107 operations), open-door maxillotomy (58 operations), and mandibulotomy (11 operations). Since the 1990s, there has been a steady decrease in the number of operations performed, mainly due to the decrease in the number of patients with rheumatoid arthritis presenting for surgery. The incidence of craniocervical junction tumors remained constant. The number of complications was significantly associated with the preoperative neurological status, and more complications were seen in myelopathic rheumatoid patients as well as a greater trend in congenital basilar invagination. The rates of pharyngeal infection (0.6%) and cerebrospinal fluid leak (0.3%) for standard transoral surgery were extremely low.CONCLUSION: The number of transoral and associated operations has decreased over time. Transoral surgery is now mainly indicated for ventral midline tumors such as chordomas. Transnasal endoscopic techniques show promise, but a major advantage of standard transoral surgery is the low cerebrospinal fluid leak and infection rates
Surgical occlusion of the leptomeningeal drainage is a safe and effective treatment for intracranial dural arteriovenous fistulas without dural sinus drainage
No full textTrigeminal neuralgia as initial symptom of paramedian tentorial meningioma
No full textPosterior cranial fossa tumours, not involving the cerebellopontine angle cistern, are a rare cause of trigeminal neuralgia (TN). We describe a patient with a large paramedian tentorial meningioma associated with acquired Chiari malformation who presented with TN. Trigeminal pain resolved after gross total tumour resection and postoperative magnetic resonance images disclosed a minimal residual tumour in the torcular region as well as ascent of cerebellar tonsils. In this article, we investigate the physiopathological hypotheses for this unusual association with emphasis on the role of tonsillar prolapse as neuropathological basis of neuropathic pain in this patient. © Springer-Verlag 2009
Clinical risk and overall survival in patients with diabetes mellitus, hyperglycemia and glioblastoma multiforme. A review of the current literature
Full text linkThe relationship between type 2 diabetes mellitus (DM2) and hyperglycemia with cancer patients remains controversial also in the setting of patients with glioblastoma multiforme (GBM), the most common and aggressive form of astrocytoma with a short overall survival (OS) and poor prognosis. A systematic search of two databases was performed for studies published up to 19 August 2020, reporting the OS of patients with DM2 or high blood sugar level and GBM and the clinical risk of diabetic patients for development of GBM. According to PRISMA guidelines, we included a total of 20 papers reporting clinical data of patients with GBM and diabetes and/or hyperglycemia. The aim of this review was to investigate the effect of DM2, hyperglycemia and metformin on OS of patients with GBM. In addition, we evaluated the effect of these factors on the risk of development of GBM. This review supports accumulating evidence that hyperglycemia, rather than DM2, and elevated BMI are independent risk factors for poor outcome and shorter OS in patients with GBM. GBM patients with normal weight compared to obese, and diabetic patients on metformin compared to other therapies, seems to have a longer OS. Further studies are needed to understand better these associations
Francesco Rizzoli (1809-1880) and the elusive case of Giulia: the description of an "arteriovenous aneurysm passing through the wall of the skull"
No full textThe improved knowledge of the clinical and haemodynamical aspects of extracranial arteriovenous malformations in the 18th century provided a foundation for the understanding and treatment of cerebrovascular pathology. It was not until the late 19th century that detailed clinicopathological reports of intracranial arteriovenous malformations were published. A seminal report by the Italian surgeon Francesco Rizzoli described Giulia, a 9-year-old girl who presented with seizures and an occipital pulsanting swelling in 1873. Rizzoli used Giulia's signs and symptoms to predict the complex angioarchitecture of her "arteriovenous aneurysm passing through the wall of skull". Postmortem examination confirmed the supposed diagnosis, and showed a direct communication between the hypertrophic branches of the ocipital artery and the transverse sinus. The clinical course of that case is briefly reviewed in this article and the diagnosis of this unusual arteriovenous shunt is discussed in light of current neurosurgical knowledge
Thoracic radiculopathy from a paravertebral mesothelial cyst
No full textWe report on an extremely rare case of a paravertebral thoracic mesothelial cyst in a young woman who presented with dorsal radiculopathy affecting the T5 dermatome. The patient underwent a standard transthoracic intercostal approach with removal of the cyst. During the operation, the T5 intercostal neurovascular bundle was found firmly attached to the lesion elucidating the origin of the radicular pain. To our knowledge, this is the first report of radiculopathy due to a paravertebral mesothelial cyst. Although highly unusual, paravertebral mesothelial cyst should be considered in the differential diagnosis for lesions inducing dorsal radicular pain. © Springer-Verlag 2006
Thrombosed giant intracavernous aneurysm with subsequent spontaneous ipsilateral carotid artery occlusion
No full textWe report a case of a 47-year-old man with a giant thrombosed aneurysm of the right cavernous internal carotid artery who initially presented with headache, double vision and trigeminal numbness. He experienced subsequent asymtomatic proximal occlusion of the parent vessel, revealed by follow-up angiography. This case illustrates the possibility that a giant thrombosed aneurysm may exert enough compression upon the parent vessel to induce flow stasis with resultant intraluminal thrombosis progressing to occlude the entire parent artery. © Springer-Verlag 2004
Extra-arachnoidal cranio-cervical decompression for syringomyelia associated with Chiari I malformation in adults: technique assessment
No full textThe osteo-dural decompression of the cerebellar tonsils at the cranio-cervical junction is generally considered the most effective treatment for syringomyelia-Chiari I complex. However much controversy concerning a great number of surgical adjuvants to the standard bony decompression is still present. In this work an extra-arachnoidal cranio-cervical decompression (CCD) without duroplasty is described and the surgical results are reported
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