1,721,031 research outputs found
Factors of surgical outcome in tumoural epilepsy
No full textThe purposes of the study were the assessment of the role of surgery in the suppression of epilepsy due to low-grade primitive cerebral tumours and the search for factors relevant to the surgical outcome
Callosotomy for severe epilepsies with generalized seizures: outcome and prognostic factors.
No full textThe purpose of the present study was to verify the effect of callosotomy on generalized seizures, to check the effect on other seizure types and to search for possible prognostic factors. Twenty patients with a minimum follow-up of one year (mean 3.5 years) were available for our analysis. In six of them the callosotomy was performed in two stages (total: 26 surgical procedures). Age ranged from 14 to 40 years (mean 23 years). Different aetiologies were known in 15 patients. Duration of epilepsy ranged from 6 to 23 years (mean 15 years). The frequency of seizures ranged between 19 and 750 per month. The most significant effect of surgery was the complete suppression of the generalized seizures associated with falling in 9/19 and their reduction of more than 80% in 7/19 patients (total "good results": 16/19). The generalized tonic-clonic seizures were less affected. The surgical effect on the partial seizures was very variable, the partial simple seizures being the most affected. A positive statistical association with the outcome of the generalized seizures with fall was found for a presurgical seizure frequency below 90 per month, a prevalent bilateral EEG epileptic activity and, to a less extent, the absence of cerebral structural lesions. The role of age, aetiology, duration of the disease, single or more seizure types, mental impairment and extent of callosotomy remains uncertain. Disconnection syndrome does not appear if the splenium is spared. The present findings confirm that the main indication for callosotomy is the occurrence of generalized seizures with fall. Surgery can be initially limited to the anterior 2/3 of the corpus callosum; further posterior section of the corpus, excluding the splenium, should be regarded as a second step, when necessary
Callosotomy for drug resistant generalized seizures
No full textWe report our series of drug resistant epileptic patients submitted to callosotomy. The 25 patients were affected by severe epilepsy with invalidating generalized seizures with fall, lacking of indication for ablative surgery. Nineteen patients, with at least 1 year of follow-up, were considered for this study. The surgical outcome was classified as: class A), seizure disappearance; class B) 80%, class C) 80-50%, class D) less than 50% seizure reduction; E) increase of seizure frequency. The follow-up analysis shows that the better results are obtained with the generalized seizures, in particular the GTA. Our surgical results are discussed considering the data of the literature: about the functional anatomy of the Corpus Callosum, the experimental studies and the clinical series published on callosotomized epileptic patients
Decompressive craniectomy and hydrocephalus
No full textdecompressive craniectomy and hydrocephalus. the aim of the study was to demostrate the role of distance from median line of craniectomy and developing of hydrocephalu
Combined treatment of advanced stages of recurrent skin cancer of the head
No full textThe authors investigated whether skull base resection and primary free-flap reconstruction in a single-stage surgery is oncologically effective for treating advanced stages of recurrent skin cancer (RSC) of the head
Post-traumatic hydrocephalus is a contraindication for endoscopic third-ventriculostomy: isn't it?
No full textOBJECTIVES:
Post-traumatic hydrocephalus (PTH) is commonly considered as a relative contraindication for endoscopic third-ventriculostomy (ETV). However, few studies are available on this topic.
METHODS:
An analysis of the papers published in the last ten years has been performed, in order to assess the level of evidence on which the current indication for ETV for PTH is based. References were identified by PubMed searches of clinical articles relating to both PTH and ETV. Laboratory investigations were excluded.
RESULTS:
Only 5 articles were selected, for a total of 15 patients with PTH treated with ETV. All these patients were described by the authors to have a communicating hydrocephalus. No complications of surgery were reported. Outcome data were not available for one patient. Thirteen out of the remaining 14 patients had a clinical improvement after the surgical procedure (93%). Direct or indirect information on pre-operative ICP was available for 11 cases. Eight of them had an elevated ICP and presented a clinical improvement after ETV.
CONCLUSIONS:
There is no current evidence to support that PTH is a contraindication for ETV. Our data suggest that we could reconsider ETV for the treatment of PTH, especially for patients with elevated ICP. Prospective clinical trials (involving several centers, due to the difficulty of recruiting patients with PTH) are needed.Objectives: Post-traumatic hydrocephalus (PTH) is commonly considered as a relative contraindication for endoscopic third-ventriculostomy (ETV). However, few studies are available on this topic. Methods: An analysis of the papers published in the last ten years has been performed, in order to assess the level of evidence on which the current indication for ETV for PTH is based. References were identified by PubMed searches of clinical articles relating to both PTH and ETV. Laboratory investigations were excluded. Results: Only 5 articles were selected, for a total of 15 patients with PTH treated with ETV. All these patients were described by the authors to have a communicating hydrocephalus. No complications of surgery were reported. Outcome data were not available for one patient. Thirteen out of the remaining 14 patients had a clinical improvement after the surgical procedure (93%). Direct or indirect information on pre-operative ICP was available for 11 cases. Eight of them had an e..
Incidental intraoperative diagnosis of Mycobacterium abscessus meningeal infection: a case report and review of the literature
No full textPurpose: Mycobacterium abscessus, and rapidly growing mycobacteria in general, are rare but increasing causes of central nervous system (CNS) infections. The aim of this study is to highlight the importance of considering these microorganism in the differential diagnosis of CNS infections, obtaining a prompt diagnosis, and improving clinical outcomes. Methods: Case report and literature review. Results: We report a case of meningeal infection in a patient who underwent decompressive craniectomy after a craniofacial trauma. The diagnosis was made analyzing a sample obtained during a second operation of cranioplasty. A regimen of amikacin, clarithromycin, and imipenem/cilastatin was started. In the following days, the patient experienced a variety of side effects. So, first clarithromycin was replaced with linezolid, then amikacin was stopped and cefoxitin added to the therapy and at the end all the antibiotics were withdrawn. The patient was discharged in good conditions and a clinical interdisciplinary follow-up was started. After 12 months, the patient is still doing well. After a literature analysis, 15 cases of M. abscessus CNS infections were identified. Various modes of acquisition, underlying disease and therapeutic schemes were evident. Conclusions: Considering the results of the literature analysis and the increasing incidence of M. abscessus, all specialists involved in the management of CNS infection should be aware of the importance of atypical microorganisms in differential diagnosis
Antiangiogenic therapy for high-grade gliomas: current concepts and limitations
No full textGlioblastoma (GBM) is associated with a high degree of angiogenesis. Therefore, antiangiogenic therapy could have a role in the treatment of this tumor. The currently available treatment approaches acting against angiogenesis are mainly directed toward three pathways: VEGF pathway, VEGF-independent pathways and inhibition of vascular endothelial cell migration. It has been demonstrated that antiangiogenic therapy can produce a rapid radiological response and a decrease of brain edema, without significantly influencing survival. Future studies should consider that: animal models are inadequate and cells used for animal models (mainly U87) are deeply different from patient GBM cells; GBM cells may become resistant to antiangiogenic therapy and some cells may be resistant to antiangiogenic therapy ab initio; and angiogenesis in the peritumor tissue has been poorly investigated. Therefore, the ideal target of angiogenesis is probably yet to be identified
Cranio-spinal subdural empyema due to S. Intermedius: A case report
No full textBACKGROUND AND PURPOSE: Subdural empyema represents a loculated infection between the dura and the arachnoid. It has been described either intracranially or in the spinal canal, the latter localization being quite rare. While treatment guidelines for a single (either brain or spinal) localization of a subdural empyema are more or less established, its management when a massive involvement of CNS is evident represents a challenge. METHODS: The authors describe a unique case of a 65-year-old woman having a massive involvement of the entire CNS with multiple localizations, both intracranial and spinal. Early diagnosis was obtained through brain CT scans followed by cranio-spinal contrast enhanced MRI scans. Patient was treated with external ventricular drainage and suboccipital craniectomy, while on antibiotic therapy. RESULTS: Patient's neurological condition gradually improved. By the end of the eighth hospital week, she was discharged without any neurological deficit. CONCLUSIONS: Spinal subdural empyema and brain subdural empyema are not always, as in our case, two different entities. Prompt diagnosis and treatment constitute the major variables affecting outcome. © 2007 by the American Society of Neuroimaging
Spontaneous chronic subdural hematomas in young adults with a deficiency in coagulation factor XIII
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