1/569. Transient paralytic attacks of obscure nature: the question of non-convulsive seizure paralysis.Eleven patients with transient paralytic attacks of obscure nature are described. paralysis could involve face or leg alone, face and hand, or face, arm and leg. The duration varied from two minutes to one day. Four patients had brain tumors, six probably had brain infarcts, and one a degenerative process. The differential diagnosis included TIAs, migraine accompaniments, and seizures. In the absence of good evidence for the first two, the cases are discussed from the standpoint of possibly representing nonconvulsive seizure paralysis (ictal paralysis, inhibitory seizure paralysis or somatic inhibitory seizure). Because of the difficulty in defining seizures as well as TIAs and migraine in their atypical variations, a firm conclusion concerning the mechanisms of the spells was not attained. Two cases of the hypertensive amaurosis-seizure syndrome have been added as further examples of ictal deficits.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/569. aneurysm occurring within a meningioma: case report.Aneurysms can be expected to be found in approximately 0.5% of patients with brain tumours; nevertheless, the real incidence is difficult to assess because angiography is now seldom performed for brain tumours. In the literature, 42 cases of meningioma associated with aneurysms are reported, but in none was the aneurysm intratumoural. We describe a case of intracranial meningioma with an intratumoural aneurysm in a 48-year-old woman.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
3/569. meningioma associated with parathyroid adenoma.A woman hospitalized because of attempted suicide with diazepam tablets was found to have hypercalcemia and other signs of hyperparathyroidism. Electroencephalogram indicated a brain lesion which was confirmed by a brain scan and angiogram. The hypercalcemia persisted after removal of the meningioma and serum levels of calcium returned to normal only after a parathyroid adenoma was removed during an additional intervention. This association of meningioma with hyperparathyroidism is unique in the literature. The difficulties of diagnosis resulting from the neuropsychiatric symptoms common to the two disorders are discussed.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
4/569. Complications of treatment: pulmonary embolism following craniotomy for meningioma.We present two case reports of patients who suffered a pulmonary embolism (PE) in the week following surgery for removal of a meningioma. Both patients were anticoagulated in the first week following surgery, and as a result, both suffered intracerebral bleeds requiring further surgery. An inferior vena caval (IVC) filter was then used in both patients to prevent further embolic events. Following our experience, we believe that it is dangerous to use intravenous anticoagulation within 6 days of cranial surgery for removal of a meningioma. We have reviewed the literature concerning the present guidelines for thromboembolic prophylaxis in patients requiring neurosurgery and believe that consideration of subcutaneous low-molecular-weight heparin should now be given to all patients requiring craniotomy for removal of a meningioma.- - - - - - - - - - ranking = 8.3376523630159keywords = cerebral, intracerebral (Clic here for more details about this article) |
5/569. Parasagittal solitary fibrous tumor of the meninges. Case report and review of the literature.The clinical, radiologic and pathologic features of a case of parasagittal solitary fibrous tumor of the meninges are reported. The patient was a 44 year-old male who presented with a complex partial seizure and a history of headaches and confusion. Radiological studies showed a large extra-axial dural-based mass in the right parietal region, predominantly isointense with gray matter and hypointense with respect to white matter on T1-weighted images, and hypointense with respect to gray matter on T2-weighted images. At surgery, the mass was very vascular, quite firm and very adherent to the convexity. Histologically the tumor was composed of spindle-shaped cells growing in fascicles within a collagenous matrix. Solitary fibrous tumor of the meninges is a newly described entity, which should be kept in mind in the clinical and radiological differential diagnosis of extra-axial brain tumors.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
6/569. A new subtype of meningioma.Three patients with small meningiomas presented with diffuse cerebral edema that was out of proportion to the size of tumors. All lesions were small and no brain invasion or unusual tumor vascularity or dural sinus involvement was noted in any of the three cases. Tumor material was subjected to conventional and immunohistochemical stains. All three tumors showed benign meningothelial components, prominent formation of hyaline inclusions (pseudopsammoma bodies), and striking vascular mural proliferation of small dark cells. All patients have remained asymptomatic without any evidence of tumor recurrence after a follow-up of 4-6 years. These tumors showed proliferation of pericytes in blood vessel walls and, therefore, represent a new subtype of meningothelial meningioma. In the study presented here, the location, size, histotype, and clinical findings that may influence the development of peritumoral brain edema are discussed in detail.- - - - - - - - - - ranking = 8.1415129839316keywords = cerebral, brain (Clic here for more details about this article) |
7/569. meningioma presenting as tolosa-hunt syndrome.A 23-year-old woman was admitted with headache, nausea, vomiting and blurred vision on the left side. Neurological examination showed ptosis with a complete internal and external ophthalmoplegia and a red fullness around the left orbita. Computed tomographic scanning of the brain revealed no abnormalities. As she improved on high doses of steroids a diagnosis of tolosa-hunt syndrome (THS) seemed to be indicated. However, magnetic resonance imaging (MRI) showed a lesion with intermediate signal intensity in the left cavernous sinus. craniotomy was performed when symptoms of THS recurred. Histopathological examination revealed a meningioma with a papillary aspect and some mitoses. This case illustrates that: (1) THS is still a diagnosis by exclusion; (2) MRI and histopathological examination are important if there is any doubt about the diagnosis; and (3) also when there is no doubt, improvement after steroid therapy may be a diagnostic pitfall. Therefore, not only MRI but also orbital phlebography and angiography should seriously be considered.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
8/569. Surgical management of intraosseous skull base tumors with aid of Operating arm System.Invasion of bone and critical neurovascular structures often impedes complete resection of intraosseous skull base neoplasms, and these lesions tend to recur unless all infiltrated bone is removed. Evolving experience with image guidance over the past few years indicates the potential value of neuronavigation in skull base lesions diffusely infiltrating or fixed to bone structures. We report our early experience with the Radionics Operating arm System (OAS), specifically emphasizing its utility as an adjunct in the treatment of intraosseous skull base tumors, mainly meningiomas. In April 1995 the OAS was introduced into clinical use at the neurosurgical university clinic in Munster, germany. Since then, the system's utility has been explored in 10 patients out of the total neuronavigation series presenting with intraosseous skull base tumors (nine females and one male, mean age 47 years; nine meningiomas, one chordoma). For navigational planning, both 3-mm computed tomography scans and a set of 3-mm fat-suppression magnetic resonance images were chosen. At least four adhesive skin markers were used for system calibration. The system was technically usable in all cases in this small series. Because of the relative immobility of the bone structures and/or the tumor, no significant deviation from the preoperative registration accuracy was noted at the end of the procedures. The main advantages were easier localization and resection of infiltrated bone, which is often not grossly identifiable, even under the microscope. Our preliminary experience with the OAS suggests that image guidance is helpful in this type of lesion, providing better anatomical orientation during surgery and delineating tumor margins and their relation to critical neurovascular structures. The problem of a possible intracranial tumor and brain shift can be neglected in these lesions. The system facilitates resection by volumetric contour information, allowing more aggressive and complete resection.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
9/569. Reverse U-shaped split temporalis musculofascial flap in cranial base reconstruction.To extend the versatility and range of the temporalis muscle, a new type of temporalis musculofascial flap was developed. This was achieved by dividing the muscle into two portions--anterior and posterior-while maintaining vascular communication between the deep and the middle temporal arteries. This flap is reverse U-shaped with one of the arms of the "U" corresponding to a pedicle, which supplies the blood, and the other corresponding to the recipient region. The bottom of the U corresponds to continuity between the anterior and posterior portions of the muscle, which contains the vascular communication. In two patients with meningioma, the flap was applied to occupy the extradural dead space combined with a pericranial flap to prevent leakage of cerebral spinal fluid to the dural defect. The reverse U-shaped split temporalis musculofascial flap has some advantages for intracranial reconstruction: sufficient rotational arc, adequate thickness, and rich vascularity. A reverse U-shaped split temporalis musculofascial flap is useful and of benefit, especially for reconstruction at the region of the anterior midline skull base.- - - - - - - - - - ranking = 7.1415129839316keywords = cerebral (Clic here for more details about this article) |
10/569. herpes simplex encephalitis after brain surgery: case report and review of the literature.Intracranial infection after neurosurgical intervention most often is caused by bacteria. A rare case of fatal herpes simplex encephalitis after removal of a meningioma is described and similar cases reported in the literature are reviewed. Recent diagnostic tools, including detection of herpes viral dna sequences by polymerase chain reaction, complement clinical suspicion and facilitate mandatory early diagnosis, because herpes encephalitis, without rapid initiation of treatment, may lead to severe disability or death.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
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