British journal of neurosurgery
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Review Case Reports
Cerebral solitary Langerhans cell histiocytosis: report of two cases and review of the literature.
Cerebral solitary Langerhans cell histiocytosis (LCH) is a very uncommon condition. We describe two new cases: a 30-year-old man with seizures and a tumour in the left frontal lobe, which was composed of a polymorphic infiltrate with a predominance of histiocytes and eosinophils; and a 65-year-old man with headaches and dysarthria, with a left parietal tumour, which showed a diffuse proliferation of histiocytic cells and areas of necrosis. In both cases, the histiocytes were strongly positive for S-100 and CD1a, and Birbeck's granules were demonstrated by electron microscopy in the first case. ⋯ They were asymptomatic after 26 and 27 months, respectively. It seems that cerebral solitary LCH is a clinicopathological entity with a good outcome. Only 15 cases of this rare process have been previously reported in the English literature.
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The objective of this study was to evaluate the magnetic resonance imaging (MRI) compatibility of metallic neurosurgical implants commonly used for cranial reconstruction and fixation, in association with a 3.0 Tesla (T) MR system. Ten metallic neurosurgical implants used for cranioplasty operations were evaluated. The implants were tested ex vivo for magnetic field interactions (translational attraction and torque), heating (using saline and gel phantoms), and artefact production [using dual echo spin echo (DSE) and gradient echo (GRE) sequences] at 3.0 Tesla. ⋯ MR artefacts were minimal with spin echo sequences; gradient echo sequences produced much larger artefacts. The neurosurgical implants evaluated in this study should not present a risk to patients undergoing MRI in the 3.0 T MR system. Although the implants do produce susceptibility artefacts, especially with gradient echo sequences, useful imaging should still be possible.
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Protein S100B is today the most promising biomarker for cerebral injury. A welcomed area for the use of such a marker is in the early stages of head trauma and diagnosis of brain injury, in particular epidural haematomas. We report five consecutive cases of epidural haematoma where serum samples for S100B were drawn at admission. ⋯ One patient with a large epidural haematoma with radiological signs of cerebral herniation displayed normal levels (0.14 microg/l) of S100B 3.5 h after the initial head trauma. Normal S100B levels in serum do not predict normal intracranial findings. S100B may be unreliable as a marker for epidural haematomas after closed head injury.
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Review Case Reports
Intraradicular lumbar disc herniation: report of two cases and review of the literature.
Intraradicular lumbar disc herniation is very rare. The exact mechanism of the dural tear by a herniated disc is not known. ⋯ We present the seventeenth and eighteenth cases of intraradicular lumbar disc herniation. We emphasise its importance and review the literature on intraradicular disc herniation.
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Internal fixation provides an increased immediate stability for the craniovertebral junction; however, there is no current consensus on the optimal method of occipitocervical (OC) fusion. In this report, we present 25 cases of craniovertebral instability treated with OC fusion by plates and screws instrumentation. The 25 cases comprised 12 men and 13 women, whose ages ranged 20 to 78 years. ⋯ The other patients showed satisfactory union after a follow-up of eight to 24 months. OC fusion using a plates and screws system is a safe and highly effective method for providing immediate internal stability to the OC junction. The internal occipital anatomy, which cannot be seen at surgery, is important when dealing with this taxing and potentially dangerous aspect of surgery.