1,721,006 research outputs found
Acute pontine syndromes following head injury
No full textPatients in the early stage of severe head injuries occasionally present with a clinical picture analogous to that in vascular or neoplastic pontine lesions and they can be identified by careful clinical examination and by repeated electroencephalography (E.E.G.). The commonest features in these cases were preservation of consciousness, constriction of the pupils, disturbances of reflex ocular motility, severe pyramidal deficits, decerebrate rigidity, myoclonic manifestations, irregular breathing, and cranial nerve palsies. An E.E.G. tracing similar to the normal pattern was a common finding. These observations suggest that pontine syndromes may be directly produceg a non-reacting, but conscious, patient for one who is deeply comatose
Intracranial meningiomas in the elderly [Meningiomi endocranici negli anziani: una sfida diagnostica prima che terapeutica].
No full textNo abstract availabl
Microsurgical removal of petroclival meningiomas: a report of 33 patients
No full textThis is a report of 33 consecutive cases of petroclival meningioma treated surgically at our institution over the last 10 years; there were 21 women and 12 men between the ages of 27 and 68 (mean age, 52). All patients were assessed by computed tomographic scans including coronal sections and bone algorithm studies; in most cases, digital subtraction angiography and magnetic resonance imaging were also done. The largest tumor diameter was between 2 and 3.5 cm in 14 cases, 3.5 to 6 cm in 15 cases, and over 6 cm in 4 cases. Dural attachment predominantly involved the clivus and apical petrous bone on one side only; in 14 cases, however, the tumor grew over the clivus midline or crossed the tentorial notch. Cranial nerve deficit was extant in all cases and was commensurate with tumor size. Cerebellar signs and somatic motor deficits were present in 60 and 30% of cases, respectively. The surgical approaches used were the retromastoid-retrosigmoid in 23 cases, subtemporal in 5 cases, and combined retromastoid subtemporal presigmoid in the remaining 5. Total removal was achieved in 26 cases (79%); incomplete removal occurred in 7 cases (21%). The extent of tumor removal and operative morbidity were not significantly related to tumor size. Brain stem indentation, arterial and cranial nerve encasement, and epidural invasion were the main factors that prevented total tumor removal and influenced operative morbidity. There was no intraoperative mortality, but three patients (9%) died perioperatively. In the postoperative period, most patients went through momentary neurological deterioration, chiefly due to new cranial nerve deficits. The average follow-up was 4.3 years in 27 patients; of these 17 were unchanged and 10 were improved. Before surgery, only 13 patients were self-sufficient; at long-term follow-up, another 6 had achieved independence. Our experience suggests that, even though real petroclival meningiomas still represent a formidable surgical challenge, such tumors can in most cases be removed completely with low attendant mortality and acceptable morbidity
Dumbbell-shaped hypoglossal neurinoma: surgical removal via a dorsolateral transcondylar approach. A case report and review of the literature
No full textA case of dumbbell-shaped hypoglossal neurinoma with intra- and extracranial extension is reported. The tumour was surgically completely removed in a one-stage operation via a dorsolateral sub-occipital transcondylar approach. Clinical presentation and the role of high-resolution CT-scan, MRI and angio-MRI in diagnosis and surgical planning are discussed. We include a review of the literature concerning these rare tumours of the foramen magnum region
Current surgical management of foramen magnum meningiomas: report of 28 cases.
No full textFew papers have been reported in literature on current management and prognosis of foramen magnum meningiomas. We present a homogeneous series of 28 cases operated on via the dorsolateral route in the semisitting position in the MRI-era. Being the dorsolateral route, a flexible approach, the extent of bone resection was tailored according to the individual case. Elderly patients (n = 11), sizable functional impairment (Karnofsky score < 70, n=21), large size of the tumors (mean diameter: 3.5 cm) and ventral or ventrolateral tumor position (n-26) characterized the case material. Total removal was achieved in all but two patients. No operative mortality occurred. The early outcome varied according to the type of preoperative dysfunction and to the surgical difficulties encountered. Whereas 95% of preoperative long tracts and cerebellar signs improved, only 15% of cranial nerves did so. Main complication was due to mild injury to the lower cranial nerves (n= 11). At final outcome (mean: 32 months), two-thirds of the cranial nerve deficits cleared and all but one patient came back to a normal life. It is concluded that microsurgical removal of ventral and ventrolateral foramen magnum meningiomas with this technique constitutes a safe arid recommended procedure
Vestibular Neurectomy and Microvascular Decompression of the Cochlear Nerve in Meniere's Disease.
No full textVestibular neurectomy (VN) results in a high success rate in the control of vertigo in Meniere's disease, although the subsequent fate of auditory function is fairly unpredictable. The present investigation reports the postoperative results obtained in a group of 30 subjects with a clinical diagnosis of Meniere's disease and vascular cross-compression of cranial nerve VIII. All subjects underwent VN using a retrosigmoid approach, and in half of them microvascular decompression (MVD) of the cochlear nerve with interposition of autogenous muscle was performed at the same time. All patients had complete relief from vertigo. Hearing was significantly improved in the VN-MVD group (46.7% of subjects). In this group tinnitus and aural fullness also improved significantly, with values of 62.6% and 66.6%, respectively
Intracranial coexistence of neurinoma with epidermoid cyst or cholesterol granuloma. Report of 2 cases
No full textThe authors present 2 cases of a rare association of intracranial tumors of different cell types: neurinoma with epidermoid cyst, and neurinoma with cholesterol granuloma. The presenting symptoms resulted from neurinomas arising from the V and VIII cranial nerves, respectively. The diagnoses were achieved using Magnetic Resonance Images (MRI). The association of these rare lesions is discussed using recent literature pertaining to the coexistence of multiple brain tumors
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