scholarly journals Encephalocele development from a congenital meningocele: case report

2017 ◽  
Vol 20 (5) ◽  
pp. 419-422 ◽  
Author(s):  
Gurpreet S. Gandhoke ◽  
Ezequiel Goldschmidt ◽  
Robert Kellogg ◽  
Stephanie Greene
Keyword(s):  
External Ventricular Drain ◽  
Fetal Mri ◽  
Neurological Deficits ◽  
Dural Defect ◽  
Mr Images ◽  
Term Birth ◽  
Cerebellar Tissue ◽  
Mri Study ◽  
Normal Cerebellum ◽  
Progressive Enlargement

A fetal MRI study obtained at 21 weeks’ gestation revealed a suboccipital meningocele without hydrocephalus. One day after term birth, MRI demonstrated an acquired cerebellar encephalocele, and MRI obtained 5 months later showed progressive enlargement of the encephalocele, still without obvious hydrocephalus. The patient underwent an operation in which an external ventricular drain was placed, the grossly normal cerebellum was reduced into the posterior fossa without resection, and the dural defect was closed. The drain was weaned out over 5 days, and no ventriculoperitoneal shunt was placed. Postoperative MR images revealed normal cerebellum and no hydrocephalus. The patient is developmentally normal. Meningocele and encephalocele are embryologically distinct. An acquired encephalocele could develop from hydrocephalus (which was not present in this case), or secondary to the lower resistance to expansion into the dural defect of the meningocele relative to the resistance to expansion of the fetal skull. The cerebellar tissue was normal in this case, and was thus preserved. The developmental prognosis is excellent. To the authors’ knowledge, this is the first reported case of this occurrence. It is important to differentiate between congenital and acquired encephalocele etiologies, because resection of the cerebellar tissue in an acquired encephalocele (as is routinely done in cases of congenital encephalocele) would be expected to result in neurological deficits.

scholarly journals Simultaneous Cranioplasty and External Ventricular Drain Implantation in Patients with Hydrocephalus: Case Series and Literature Review

2021 ◽  
Author(s):  
Lívio Pereira de Macêdo ◽  
Arlindo Ugulino Netto ◽  
Kauê Franke ◽  
Pierre Vansant Oliveira Eugenio ◽  
John Anderson da Silva Rocha ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Neurological Complication ◽  
Case Series ◽  
Neurological Deficits ◽  
Time Interval ◽  
Automobile Accidents ◽  
Decompressive Hemicraniectomy ◽  
Cerebral Herniation ◽  
Intraoperative Period ◽  
The Brain

Abstract Introduction The increase in intracranial pressure (ICP) is a neurological complication resulting from numerous pathologies that affect the brain and its compartments. Therefore, decompressive craniectomy (DC) is an alternative adopted to reduce ICP in emergencies, especially in cases refractory to clinical therapies, in favor of patient survival. However, DC is associated with several complications, including hydrocephalus (HC). The present study presents the results of an unusual intervention to this complication: the implantation of an external ventricular drain (EVD) in the intraoperative period of cranioplasty (CP). Methods Patients of both genders who presented with HC and externalization of the brain through the cranial vault after decompressive hemicraniectomy and underwent EVD implantation, to allow the CP procedure, in the same surgical procedure, were included. Results Five patients underwent DC due to a refractory increase in ICP, due to automobile accidents, firearm projectiles, falls from stairs, and ischemic strokes. All evolved with HC. There was no uniform time interval between DC and CP. The cerebrospinal fluid (CSF) was drained according to the need for correction of cerebral herniation in each patient, before undergoing cranioplasty. All patients progressed well, without neurological deficits in the immediate postoperative period. Conclusion There are still several uncertainties about the management of HC resulting from DC. In this context, other CP strategies simultaneous to the drainage of CSF, not necessarily related to ventriculoperitoneal shunt (VPS), should be considered and evaluated more deeply, in view of the verification of efficacy in procedures of this scope, such as the EVD addressed in this study.

scholarly journals Ruptured Bilateral Pericallosal Artery Aneurysm in Mirror Position: Case Report

2018 ◽  
Vol 37 (03) ◽  
pp. 263-266
Author(s):  
Lucas Meguins ◽  
Linoel Valsechi ◽  
Ronaldo Fernandes ◽  
Dionei Morais ◽  
Antonio Spotti
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Artery Aneurysm ◽  
Operative Management ◽  
Neurological Deficits ◽  
Pericallosal Artery ◽  
Digital Subtraction Arteriography ◽  
The Many ◽  
The Right

Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult. Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position. Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed ∼ 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts. Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operative management of ruptured bilateral PA aneurysms is feasible and effective.

Ventral “Spinal Epidural Meningeal Cysts”—Not Epidural and Not Cysts? Case Series and Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Bret Gene Ball ◽  
Patrick H. Luetmer ◽  
Caterina Giannini ◽  
Bahram Mokri ◽  
Neeraj Kumar ◽  
...  
Keyword(s):  
Relevant Literature ◽  
Case Series ◽  
Signs And Symptoms ◽  
Spinal Pain ◽  
Neurological Deficits ◽  
Definitive Treatment ◽  
Dural Defect ◽  
Computed Tomographic Myelography ◽  
Meningeal Cysts ◽  
Spinal Epidural

Abstract BACKGROUND: Ventral spinal epidural meningeal cysts are rare entities for which the pathogenesis is poorly understood. OBJECTIVE: We present the clinical, radiographic, surgical, and pathologic findings of 4 patients with extensive ventral spinal epidural meningeal cysts and review the relevant literature. In addition, we discuss a suspected mechanism for pathogenesis. METHODS: Four patients with anterior spinal epidural meningeal cysts are retrospectively reviewed. RESULTS: Ventral spinal epidural meningeal cysts are often large, extending on average from C2 to L1 in our series. Patients typically present with a prolonged course of symptoms and signs, including segmental muscle weakness and atrophy, subtle myelopathy, mild to moderate spinal pain, and headache. Histopathologic analysis of the cyst wall demonstrates collagenous tissue consistent with dura but without arachnoid features. Dynamic computed tomographic myelography is the study of choice for localization of the primary dural defect. Patient symptoms and neurological deficits routinely improve after appropriate surgical intervention. CONCLUSION: Diverse signs and symptoms herald the presentation of ventral spinal meningoceles. Intraoperative, radiographic, and pathological findings are all suggestive of an intradural dissection as the etiology. Hence, they may be more appropriately named “ventral spinal intradural dissecting meningoceles.” Definitive treatment involves identification and obliteration of the dural defect.

Superficial siderosis: bleeding from the bone marrow after laminectomy for spinal tumor removal

2014 ◽  
Vol 21 (6) ◽  
pp. 905-908 ◽  
Author(s):  
Junichi Yokosuka ◽  
Keisuke Takai ◽  
Takashi Komori ◽  
Makoto Taniguchi
Keyword(s):  
Bone Marrow ◽  
Residual Tumor ◽  
Spinal Tumor ◽  
Neurological Deficits ◽  
Superficial Siderosis ◽  
Dural Defect ◽  
Bleeding Source ◽  
Subarachnoid Bleeding ◽  
Surgical Data ◽  
Intrathecal Space

Superficial siderosis of the CNS is a rare disease characterized by the deposition of hemosiderin in the subpial layers of the CNS as the result of chronic subarachnoid bleeding. The arrest of bleeding is important for preventing the progression of this disease; however, the exact source of bleeding remains unknown in most cases because of a lack of objective surgical data. The authors of this report have described a unique case of superficial siderosis following cervical laminectomy and autograft fusion for the removal of a spinal schwannoma; the bleeding source was verified by intraoperative and histopathological findings. The patient exhibited no obvious neurological deficits, such as hearing loss or cerebellar ataxia, when the superficial siderosis was diagnosed, although there were the social impairments associated with schizophrenia. During repair surgery, the bleeding source was revealed as the bone marrow vasculature of the remaining vertebral arch, and not the fragile vessels at the dural defect or the residual tumor. Chronic bleeding was stopped before the onset of irreversible neurological deficits in this case. Bone marrow exposed to the intrathecal space may represent a chronic bleeding source in patients with superficial siderosis following CNS surgery including laminectomy or craniotomy. The following recommendations have been proposed for superficial siderosis of the CNS from both a preventative and a therapeutic perspective: 1) During CNS surgery, neurosurgeons should make every effort to prevent exposing bone marrow to the intrathecal space to avoid the risk of chronic subarachnoid bleeding. 2) In the case of a large dural defect and pseudomeningocele following CNS surgery, bone marrow around the dural defect should be considered as the bleeding source of superficial siderosis, and such cases should undergo revision surgery before the progression of this disease.

Intramedullary spinal cord lipomas

1995 ◽  
Vol 82 (3) ◽  
pp. 394-400 ◽  
Author(s):  
Mark Lee ◽  
Ali R. Rezai ◽  
Rick Abbott ◽  
Daniel H. Coelho ◽  
Fred J. Epstein
Keyword(s):  
Spinal Cord ◽  
Single Case ◽  
Case Reports ◽  
Spinal Dysraphism ◽  
Neurological Deficits ◽  
Rapid Progression ◽  
Dural Defect ◽  
Intramedullary Spinal Cord ◽  
Presenting Symptoms

✓ Spinal cord lipomas are rare lesions, accounting for approximately 1% of all spinal cord tumors. True intramedullary spinal cord lipomas are extremely rare and are represented in the literature as scattered, single case reports. The authors present a series of six patients with intramedullary spinal cord lipomas managed at our institution from July, 1985 to July, 1993. The patients' ages ranged from 8 to 45 years. Four patients presented with newly diagnosed tumors and two had undergone previous surgery. Patients usually presented with long histories of disability followed by rapid progression of their symptoms. Most patients were in poor neurological condition on presentation. Presenting symptoms included spinal pain, dysesthetic sensory changes, gait difficulties, weakness, and incontinence. Three patients had cervical tumors, two had cervicothoracic tumors, and one patient had a thoracic tumor. Diagnostic studies, including magnetic resonance imaging, were obtained in all patients. No patient exhibited any form of spinal dysraphism or had a dural defect. All patients underwent decompressive, subtotal resections of 40% to 70% of their lesions. Follow-up times ranged from 12 to 96 months. All patients had resolution of their pain, but they generally showed no neurological improvement. As of their most recent follow-up visit, none of the patients was neurologically normal; three can function independently, although with neurological deficits. The other three patients cannot function independently and have severe neurological deficits. The authors conclude that patients with intramedullary spinal cord lipoma who present with significant neurological compromise have a very poor prognosis with regard to neurological function and generally show no improvement with surgical resection.

scholarly journals Normal human brainstem development in vivo: a quantitative fetal MRI study

2020 ◽  
Author(s):  
G. O. Dovjak ◽  
V. Schmidbauer ◽  
P. C. Brugger ◽  
G. M. Gruber ◽  
M. Diogo ◽  
...  
Keyword(s):  
Fetal Mri ◽  
Normal Human ◽  
Mri Study

Safety of spinal decompression using an ultrasonic bone curette compared with a high-speed drill: outcomes in 337 patients

2013 ◽  
Vol 18 (6) ◽  
pp. 627-633 ◽  
Author(s):  
Mohamad Bydon ◽  
Risheng Xu ◽  
Kyriakos Papademetriou ◽  
Daniel M. Sciubba ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
Spine Surgery ◽  
High Speed ◽  
Soft Tissues ◽  
Hospital Length Of Stay ◽  
Neurological Deficits ◽  
Perioperative Outcomes ◽  
Dural Defect ◽  
Spinal Decompression ◽  
Safety And Efficacy ◽  
Incidental Durotomy

Object Unintended durotomies are a common complication of spine surgery and are often correlated with increased postoperative morbidity. Recently, ultrasonic bone curettes have been introduced in spine surgery as a possible alternative to the conventional high-speed drill, offering the potential for greater bone-cutting precision and less damage to surrounding soft tissues. To date, however, few studies have investigated the safety and efficacy of the ultrasonic bone curette in reducing the rates of incidental durotomy compared with the high-speed drill. Methods The authors retrospectively reviewed the records of 337 consecutive patients who underwent posterior cervical or thoracic decompression at a single institution between January 2009 and September 2011. Preoperative pathologies, the location and extent of spinal decompression, and the use of an ultrasonic bone curette versus the high-speed drill were noted. The rates of incidental durotomy, as well as hospital length of stay (LOS) and perioperative outcomes, were compared between patients who were treated using the ultrasonic bone curette and those treated using a high-speed drill. Results Among 88 patients who were treated using an ultrasonic bone curette and 249 who were treated using a high-speed drill, 5 (5.7%) and 9 (3.6%) patients had an unintentional durotomy, respectively. This finding was not statistically significant (p = 0.40). No patients in either cohort experienced statistically higher rates of perioperative complications, although patients treated using an ultrasonic bone curette tended to have a longer hospital LOS. This difference may be attributed to the fact that this series contained a statistically higher number of metastatic tumor cases (p < 0.0001) in the ultrasonic bone curette cohort, likely increasing the LOS for that patient population. In 13 patients, the dural defect was repaired intraoperatively. No patients who experienced an incidental durotomy had new-onset or permanent neurological deficits postoperatively. Conclusions The safety and efficacy of ultrasonic bone curettes in spine surgery has not been well established. This study shows that the ultrasonic bone curette has a similar safety profile compared with the high-speed drill, although both are capable of causing iatrogenic dural tears during spine surgery.

Successful long-term deep brain stimulation for hemichorea—hemiballism in a patient with diabetes

2005 ◽  
Vol 102 (6) ◽  
pp. 1137-1141 ◽  
Author(s):  
Naoki Nakano ◽  
Takuya Uchiyama ◽  
Takeshi Okuda ◽  
Masahiko Kitano ◽  
Mamoru Taneda
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Diabetic Coma ◽  
Mr Images ◽  
Content Type ◽  
First Case ◽  
Fine Print ◽  
Deep Brain

✓ The authors report a case of hemichorea—hemiballism (HC-HB) that was successfully treated using deep brain stimulation (DBS). A 65-year-old right-handed man exhibited a sudden onset of right HC-HB without a diabetic coma. At admission T1-weighted magnetic resonance (MR) images revealed a high-intensity signal in the left striatum, contralateral to the patient's involuntary movements. The HC-HB continued for 5 months after onset of the condition despite medical treatment and a decreased intensity of the signal on T1-weighted MR images. The patient underwent placement of a quadripolar DBS electrode in the left thalamus, including the left ventral oralis (VO) anterior and posterior nuclei (the VO complex). Postoperatively, the right-sided HC-HB disappeared rapidly during electrical stimulation and there were no neurological deficits. The authors demonstrate that DBS can be an effective treatment for medically refractory HC-HB. This is the first case of HC-HB that has been successfully treated with DBS.

Rostral cerebellar arterial infarct in two cats

2007 ◽  
Vol 9 (3) ◽  
pp. 246-253 ◽  
Author(s):  
Giunio Bruto Cherubini ◽  
Clare Rusbridge ◽  
Bhanu P. Singh ◽  
Sandra Schoeniger ◽  
Paul Mahoney
Keyword(s):  
Diagnostic Value ◽  
Neurological Deficits ◽  
Low Grade ◽  
Presumptive Diagnosis ◽  
Mri Features ◽  
Siamese Cat ◽  
Fluid Attenuated Inversion Recovery ◽  
Mri Study ◽  
Cerebellar Infarct

A 10-year-old female neutered domestic shorthair (DSH) cat and a 6-year-old female neutered Siamese cat were presented following a peracute onset of decerebellate rigidity and a cerebellar vestibular syndrome, respectively. In both cats, physical examination and routine blood tests were unremarkable, as was routine analysis of cerebrospinal fluid obtained from the DSH cat. Based on the magnetic resonance imaging (MRI) features – focal wedge-shaped lesion in the cerebellum characterised by hyperintensity in T2-weighted, T2∗-gradient echo and fluid attenuated inversion recovery (FLAIR) images – a presumptive diagnosis of cerebellar infarct was made in both cases. In the DSH cat, the post-mortem examination confirmed the diagnosis of cerebellar infarct and additionally found acute renal infarcts and a pulmonary neoplasia. In the Siamese cat, ultrasonographic evaluation of the heart revealed a probable low-grade chronic valvular endocarditis which was thought to be a potential source of thromboembolism. This paper describes the first two cases – one confirmed and the other suspected – of cerebellar infarct in the cat. The in vivo potential diagnostic value of the MRI study is highlighted. Cerebellar infarcts should be included in the differential diagnosis of cat with a peracute onset of cerebellar signs regardless of the severity of neurological deficits.

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