The Internet Journal of Neurosurgery最新文献

{"title":"Intradural extramedullary tuberculoma in non-HIV-infected patient. A case report.","authors":"A. Hossini, W. Ammouri, K. Quenum, N. Fatemi, N. Raouzi, A. Saïdi, M. Jiddane, F. Bellakhdar","doi":"10.5580/443","DOIUrl":"https://doi.org/10.5580/443","url":null,"abstract":"Intradural extramedullary tuberculoma of the spinal cord is a very rare presentation of non osseous spinal tuberculosis. We reported on, a case of a 22 year-old female who was treated for pulmonary tuberculosis since five months. The patient developed spastic paraplegia, which progressed rapidly, 20 days before admission. MRI of spine revealed an intradural extramedullary lesion at the T3-T4 and T7-T12 levels. After surgery, the histopathology of the lesion confirmed the diagnosis of tuberculosis.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128176848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Death, dying and the neurosurgeon: a trainee’s perspective","authors":"Andre des Etages","doi":"10.5580/236e","DOIUrl":"https://doi.org/10.5580/236e","url":null,"abstract":"Neurosurgical trainees face many challenges, both personal and professional during their training. By far and large, undergraduate and postgraduate medical training prepares you for the academic commitments faced during one’s training. However, precious few have had formal training in dealing with the dying patient or for that matter in helping bereaved relatives cope with impending loss or the death of a loved one. This article will attempt to highlight some of the aspects of death and dying from the perspective of the neurosurgeon and hopes to make useful suggestions on coping strategies for the patient, the relatives and indeed the physician. CLASSIFICATION OF LOSS AND PERSONS AFFECTED Coping with loss in the field of neurosurgery can be artificially divided into three main categories, the patient, the patient’s relatives and the caregiver. Within each of these categories lie two broad artificial sub-headings; expected and unexpected loss. A compassionate approach is required to deal with all concerned within each of these areas. Unexpected events are naturally more difficult to cope with than events that are planned for in advance. Support systems are required for each group, regardless of age and experience of dealing with loss, be it loss of independence, terminal illness, death and dying. An attempt to classify illnesses into these groups is illustrated below.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117006533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post operative pituitary apoplexy in a case of giant pituitary adenoma","authors":"T. Govindan, D. Sivashanmugam","doi":"10.5580/44a","DOIUrl":"https://doi.org/10.5580/44a","url":null,"abstract":"Giant pituitary adenomas are relatively rare and their management challenging. This article presents such a case, which developed post operative pituitary apoplexy. The case details and the pertinent literature are discussed. Introduction Giant pituitary adenomas are relatively rare tumors and their management complex and challenging . Most present with a combination of visual and endocrinological dysfunction . Surgical approach could be trans sphenoidal, trans cranial, or a combination of the two . While total excision has been reported, the occurrence of complications, especially pituitary apoplexy, and the generally poor prognosis following this are reported sporadically but well documented 2, 4, . This article presents one such case and reviews the literature. Case Report A 49 years old Tanzanian, was referred to our institution as a case of giant pituitary adenoma, which was diagnosed about a year back in Tanzania, where he had sought medical advice for visual problems. Examination revealed a well built, obese individual, with gynaecomasia, visual defects in the form of no PL in the left eye and 3/60 vision in the lower nasal quadrant of the right eye, and bilateral POA in both fundi. Plain x ray skull lateral showed a ballooned sella. Plain and contrast enhanced CT of the brain showed a large sellar, supra sellar and intra sphenoidal sinus mass, extending up to the level of the corpus callosum, with no hydrocephalus. MRI (plain and contrast enhanced) and MRA confirmed the same. His hormonal work-up was within normal limits. Pre operative contrast enhanced CT Pre operative contrast enhanced MRI He was adequately prepared with steroids and intra nasal antibiotics and taken up for a trans sphenoidal approach to the mass. The tumor was encountered in the sphenoidal sinus itself as expected. It was quite vascular and very fibrous, thus limiting the surgery to the sphenoidal and sellar portion of the tumor. He was kept sedated and ventilated post operatively; during the times he could be assessed when light on sedation, he was conscious with no focal neurological deficit. Biopsy was reported as typical of pituitary adenoma. About 14 hours post surgery, he suddenly developed hypotension, which required ianotrophs. Within half an hour, he became totally unconscious (GCS 3/15), with dilated and non reactive pupils. He soon developed features of frank diabetes insipidus, which was appropriately tackled. Plain CT scan brain, once he was stable to be shifted, showed intra tumoral bleed, enlarging the adenoma; there was also pan ventricular hemorrhage with hydrocephalus. Post operative plain CT Bilateral frontal EVDs were inserted, with no subsequent improvement. He was soon assessed to be brain dead and expired after 24 hours of the ictus. Discussion Pituitary adenomas whose size exceeds 4 cms are called giant pituitary adenomas . Giant pituitary adenomas are not special entities by themselves but unusual examples of locally invasive tumors 2 . These t","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125982767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subperiosteal Hematoma Of The Orbit Secondary To Sinusitis: Report Of An Unusual Case","authors":"M. Turgut, Y. Ozsunar, brahim Meteo lu, H. Eyigör","doi":"10.5580/1a12","DOIUrl":"https://doi.org/10.5580/1a12","url":null,"abstract":"Subperiosteal hematoma of the orbit is a rare complication of ethmoidal sinusitis presenting most commonly in adults. The authors report a unique case who had subperiosteal hematoma of the orbit secondary to ethmoidal sinusitis. She was referred to our hospital with the diagnosis of orbital abscess and magnetic resonance imaging disclosed an extraconal mass in the upper part of the left orbit. A left frontal craniotomy was performed after aspiration of purulent material from ethmoid sinus using endoscopic approach, and a brownish black hematoma material was removed. This patient is the second reported case of subperiosteal hematoma of the orbit misdiagnosed as orbital abscess in the current literature. The presented case exemplifies the fact that early diagnosis and prompt intervention is very important to avoid possible complications often associated with this disease.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124404835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case in which motor evoked potential could be elicited despite an increase in remifentanil dose during craniotomy.","authors":"T. Kunisawa, Mitsuteru Oikawa, Tamio Ito, A. Kurosawa, S. Hanada, H. Iwasaki","doi":"10.5580/2cd","DOIUrl":"https://doi.org/10.5580/2cd","url":null,"abstract":"We performed anesthetic management for craniotomy, during which motor evoked potential (MEP) was elicited by direct motor cortex stimulation (DMS), in a female patient with brain aneurysm. Propofol and remifentanil were used for anesthetic induction and maintenance. The propofol concentration was adjusted in accordance with bispectral index value, and the remifentanil concentration was adjusted in accordance with the hemodynamic values. Although we planned to use a remifentanil dose of 0.2 �og/kg/min on the basis of a previous report, the dose had to be increased to 0.5�og/kg/min, the effect-site concentration was calculated to be 17.2 ng/mL by using a pharmacokinetic simulation, which was in accordance with the hemodynamic values. However, MEP could be well elicited throughout MEP monitoring. This finding was consistent with that of previous studies in which MEP was elicited by transcranial electrical stimulation (TCS) or transcranial magnetic stimulation (TMS). Emergence from anesthesia is well, and no side effects or new neurological deficits occurred. It is thought remifentanil might have also a wide dosage window with respect to monitoring MEP elicited by DMS.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133481255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant frontal mucocele invading the anterior cranial fossa and orbit","authors":"Piotr Be dzi ski, Pawe S oniewski, Daniel R c awowicz","doi":"10.5580/2698","DOIUrl":"https://doi.org/10.5580/2698","url":null,"abstract":"Mucocele is a rare intracranial pathology. In majority mucoceles arise within the frontal and ethmoid sinuses. Intracranial and intraorbital extensions are uncommon. A 48 year old male with a history of head trauma with multiple craniofacial fructures for 30 years. After 30 years came to first generalized epileptic seizure, also the leftside exophthalmos was observed. The radiological investigations, computed tomography ( CT ) and magnetic resonanse ( MRI ), showed large extracerebral pathological mass invading the left frontal and ethmoid sinuses, left orbit and anterior cranial fossa with left frontal lobe compression. The left side fronto basal craniotomy was performed. The histopathological diagnosis was mucocele. Postoperative neurological examination revealed no deficit. The patient was seizures free and in good condition discharged from the department.Mucocele is a rare, benign pathology arising intracranial from the sinuses. The results are good, the frequency of complication is low.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131052140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Cervical PNET mimicking as neurofibroma. A case report","authors":"Pranav Ghodgaonkar, V. Velho, R. Mally, A. Jaiswal","doi":"10.5580/f7e","DOIUrl":"https://doi.org/10.5580/f7e","url":null,"abstract":"Primitive Neuro Ectodermal tumor (PNET) are the lesions commonly occurring in intracranial locations, more often in children and young adult. These are aggressive and highly malignant tumors which may spread through CSF to the spinal cord. Occurrence of primary spinal PNET is rare. In the cord these can arise at any level and may be intramedullary, extramedullary or extradural in location. The appearance on MR studies may mimic a neurofibroma with intra and extradural components. The management includes surgical excision, radiotherapy and adjuvant chemotherapy. Despite good surgical excision, due to the aggressive nature of the tumor recurrence is likely and the life expectancy remains poor. An 18 year old right handed male presented with the complaint of pain in the neck and progressive weakness in both the upper and lower limbs more on left then right side of 4 month duration. Examination revealed wasting of the deltoid, supraspinatus and infraspinatus muscles on left side. Tone was increased in both lower limbs and the reflexes were brisk. Power was grade IV/V in RUL and RLL and III/V in LUL and LLL. Contrast MRI showed an extramedullary intradural mass of 3.4x1.2x1.7 cms in the spinal canal at C2 – C3 level compressing the cord and was extending to the C2 C3 neural foramen and thought to be neurofibroma with a major extradural component arising from the nerve root foramen. The patient was operated via C1-C4 laminectomy. Intra operative inspection revealed a large, vascular and firm tumor which had a major extradural component and was adherent to the left vertebral artery. The dura was opened and the intra and extradural components were excised. The intra foraminal portion of the tumor, which was adherent to the left vertebral was left. Histopathological examination revealed a highly cellular tumor which was infiltrating the surrounding meningeal and fibrocollagenous tissue with tumor cells arranged in small sheets suggestive of Primitive Neuro Ectodermal tumor (PNET). The patient did well after surgery and his power in upper and lower limbs improved to grade V on both the sides. A contrast CT scan of brain did not reveal any primary lesion in the brain thus ruling this out as a secondary lesion in the spine. The patient was advised adjuvant radiotherapy and chemotherapy, but was unable to take the treatment due to financial constraints. On follow up at the end of 4 months he was doing well. 6 months later he presented to us again with recurrence of progressive weakness in upper and lower limbs, as well as difficulty in breathing. A recurrence of the tumor was suspected and MRI of the cervical spine was repeated. This time it revealed two lesions; one at the previous (C2-3) level and the second lesion at the foramen magnum, which was compressing the cervico medullary junction anteriorly and encasing both vertebral arteries, which was a new development. The patient was re operated and both the lesions were excised by a posterior midline approac","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121821658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Chronic Subdural Haematoma After Endoscopic Third Ventriculostomy: Case Report and Review of the Literature","authors":"I. Emmanuel, A. Michael","doi":"10.5580/2995","DOIUrl":"https://doi.org/10.5580/2995","url":null,"abstract":"Several complications related to Endoscopic third ventriculostomy (ETV) have been reported in the literature including chronic subdural haematoma. This is usually unilateral. We report a case of a 12-month-old female child with bilateral chronic subdural haematoma (CSH) 3months after an ETV. She had a ventriculoperitoneal shunt at 5months of age on account of congenital aqueductal stenosis with marked cerebral mantle thining. At 9months of age an ETV was done due to shunt obstruction. The CSH was successfully treated by burr-hole evacuation on both sides. Though ETV is a simple, effective and safe procedure, and also the main stay of treatment for noncommunicating hydrocephalus in many centres, long term follow up should still be emphasised.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128645634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhabdoid Meningioma In A Background Of Atypical Meningioma With Lipomatous Metaplasia: Case Report And Review Of Literature","authors":"S. Shuja, T. Lucey, Victor R. Dasilva, Raafat Maakary","doi":"10.5580/1409","DOIUrl":"https://doi.org/10.5580/1409","url":null,"abstract":"Meningiomas are heterogenous in their histology, and most of histologic subtypes have no prognostic significance, and are classified as WHO grade 1. Those with clinically increased risk of recurrence are classified as WHO grade II or III. A relatively recent addition to the meningioma family is a rare variant called rhabdoid meningioma, which is associated with increased risk of recurrence and aggressive clinical behavior and therefore classified as WHO grade III meningioma. We report a case of rhabdoid meningioma in a 43 year old man, which exhibited an unusual combination of rhabdoid and lipomatous components, in a background of atypical meningioma. The clinical features, neuroimaging, surgical treatment results and pathological features of this case are described with a limited review of literature regarding prognosis of patients and treatment options.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133987582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transient Oculomotor Nerve Palsy After Subarachnoid Hemorrhage Due To Middle Cerebral Artery Aneurysm","authors":"A. Wani, Vipul Gupta, M. Chugh, A. Jha, B. Walia, S. Vaishya, A. Gupta, G. Rahmathulla","doi":"10.5580/24a8","DOIUrl":"https://doi.org/10.5580/24a8","url":null,"abstract":"Oculomotor nerve (ON) palsy after subarachnoid hemorrhage due to middle cerebral artery (MCA) aneurysm is a rare entity with very few reported cases in literature. A 55-year-old male presented with subarachnoid hemorrhage due to ruptured MCA aneurysm on left side with partial left (ON) palsy. The patient had no clinical or radiological feature of raised intracranial pressure. The patient underwent endovascular coiling following, which there was complete recovery within two days. The involvement of ON in MCA aneurysm and such rapid recovery has not been reported before.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133295759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}