Neurosurgery
-
During the period from 1977 to August 1992, 100 intramedullary tumors in 94 patients were operated on in the Department of Neurosurgery at the Nordstadt Hospital in Hannover, Germany. Of these, 45% presented with associated syringes. A syrinx was more likely to be found above (49%) than below (11%) the tumor level. ⋯ However, surgical results and long-term prognosis were not influenced significantly by an associated syrinx. The most important factor determining long-term outcome was the preoperative level of neurological function. We propose that factors independent of the tumor, disturbances of cerebrospinal fluid and extracellular fluid flow in particular, have major roles in the pathogenesis of syrinx formation associated with intramedullary tumors.
-
Desmoid tumors are uncommon fibroblastic proliferative lesions usually occurring in the abdominal wall of adults. We report an unusual case of such a tumor presenting as a rapidly growing cervical paraspinous mass in a 19-month-old girl. After surgical resection without adjuvant therapy, the child is recurrence free after 17 months. ⋯ We found magnetic resonance imaging to be the best imaging method for evaluation, because it was able to distinguish the tumor from the surrounding muscle. Careful postoperative surveillance is warranted, because these tumors have a high rate of recurrence. Although rare, desmoid tumor should be considered in the differential diagnosis of a paraspinous soft tissue tumor in a pediatric patient.
-
Endoscopic resection of a cavernous angioma at the subthalamic region was performed in a 33-year-old woman who presented with diplopia and progressive hemiparesis caused by recurrent hemorrhages. The entire surgical procedure was done through an 8-mm guiding tube inserted stereotactically from a frontal burr hole via an approach that traversed the anterior limb of the internal capsule. The patient's symptoms improved after surgery. This is believed to be the first report describing successful resection of a cavernous angioma located at the subthalamic region.
-
Intracranial section of the glossopharyngeal and upper vagal rootlets for the treatment of vagoglossopharyngeal neuralgia may cause dysphagia or vocal cord paralysis from injury to the motor vagal rootlets in 10% to 20% of cases. To minimize this complication, we recently applied a technique of intraoperative monitoring of the vagus nerve (previously described by Lipton and McCaffery to monitor the recurrent laryngeal nerve during thyroid surgery) in a patient undergoing intracranial rhizotomy for vagoglossopharyngeal neuralgia. ⋯ In this patient, the technique allowed us to preserve a rostral vagal rootlet, which if sectioned, could have caused dysphagia or vocal cord paralysis. We conclude that intraoperative monitoring of the rostral vagal rootlets is an important technique to minimize complications of upper vagal rhizotomy.
-
Hypericin, a polycyclic aromatic dione isolated from plants, is presently being clinically evaluated as an antiviral agent in the treatment of human immunodeficiency virus (HIV) infection. In addition, it is known to be a potent protein kinase C inhibitor. To evaluate its potential as an inhibitor of glioma growth, an established (U87) and low-passage glioma line (93-492) were treated with hypericin in tissue culture for a period of 48 hours after passage. ⋯ Cells were harvested, and purified deoxyribonucleic acid (DNA) was analyzed by agarose gel electrophoresis. DNA from cells treated with hypericin for 48 hours exhibited a classical "ladder" pattern of oligonucleosome-sized fragments characteristic of apoptosis. These data suggest that the proven safe drug hypericin may have potential as an antiglioma agent; we suggest clinical trials.