1/16. Resolution of tonsillar herniation and syringomyelia after supratentorial tumor resection: case report and review of the literature.OBJECTIVE AND IMPORTANCE: The pathophysiological features of syringomyelia are not yet entirely understood. We present a case of a supratentorial mass causing tonsillar herniation and syringomyelia. CLINICAL PRESENTATION: A 51-year-old woman underwent magnetic resonance imaging for evaluation of progressive headaches. A large parieto-occipital mass was revealed. Herniation of the cerebellar tonsils and a cervical syrinx were also noted. INTERVENTION: A craniotomy was performed without incident. After tumor resection, the tonsils ascended and the syrinx resolved in a 1-year period. CONCLUSION: This case highlights the importance of tonsillar herniation in the pathogenesis of syringomyelia. "Acquired" Chiari malformations and syringomyelia attributable to supratentorial masses may be treated by mass resection alone, without the need for foramen magnum decompression.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/16. A huge frontal meningioma associated with intraoperative massive bleeding and severe brain swelling--case report.A 58 year old female presented with progressive memory disturbance and personality change. Magnetic resonance (MR) imaging disclosed a huge mass lesion accompanied by prominent oedema in the right frontal lobe. Cerebral angiogram demonstrated a vascular-rich tumour and a major drainer through diploic vein. A right frontotemporal craniotomy was performed. We encountered massive bleeding from diploic vein and dura mater immediately at the craniotomy. We were also faced with severe brain swelling at the dural incision. The tumour was solid, highly vascularised, and fairly well demarcated. We performed total removal of the tumour as quickly as possible in order to reduce the intracranial hypertension and avoid the impending brain herniation. The patient had an uneventful recovery and was asymptomatic at 10 months follow-up.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
3/16. Infrared pupillometry during uncal herniation.Infrared pupillary scans have been used extensively as an objective measure of pupillary reflexes during pharmacological studies of human subjects, but no previous scans have documented the pupillary changes during transtentorial uncal herniation. We present infrared pupillary scans from three patients with brain stem compression secondary to expanding intracranial mass lesions. The scans were made with a portable device permitting infrared pupillometry at the patient's bedside. Portable infrared pupillometry records objective measurements of pupillary light reflexes, which provides information useful for diagnosing transtentorial herniation and affords objective measurements of an important endpoint in the management of patients with head trauma or supratentorial mass lesions.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
4/16. Reverse brain herniation during posterior fossa surgery.Posterior fossa tumors are commonly associated with obstructive hydrocephalus. Relieving the raised intracranial pressure by draining the cerebrospinal fluid presents the possibility of reverse herniation of the brain. A 5-year-old male child with a diagnosis of posterior fossa space-occupying lesion and hydrocephalus was scheduled for craniectomy in the prone position. After craniectomy, the surgeons placed an intraventricular shunt catheter to drain out cerebrospinal fluid in an attempt to reduce the tense brain so as to facilitate easy dissection of the tumor. The patient had sudden and severe bradycardia followed by asystole. A diagnosis of reverse coning was made. Immediately, the surgeon injected 10-15 mL normal saline into the ventricles. There was a spontaneous return of the sinus rhythm and the rest of the course of surgery was uneventful. We present this case showing a rare phenomenon and its successful management.- - - - - - - - - - ranking = 0.83333333333333keywords = herniation (Clic here for more details about this article) |
5/16. Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery. Report of three cases.The authors discuss the cases of three patients in whom thoracic paraplegia developed after lumbar spinal decompressive surgery for slight lumbar spinal canal stenosis. Careful computerized tomography myelography and magnetic resonance imaging examination of the thoracic spine revealed another compressive lesion (spinal cord tumor, disc herniation, osteophyte of vertebral body, and ossification of the ligamentum flavum). Additional thoracic decompressive surgery provided partial amelioration of each patient's neurological condition. The authors suggest that to avoid such a complication physical and radiographic examination of the thoracic spine should be performed preoperatively if the lumbar imaging is inconclusive.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
6/16. Paradoxical cerebral herniation secondary to lumbar puncture after decompressive craniectomy for a large space-occupying hemispheric stroke: case report.OBJECTIVE AND IMPORTANCE: The risk of transtentorial herniation after removal of cerebrospinal fluid from the lumbar cistern in the setting of a supratentorial lesion with significant mass effect, increased cerebrospinal fluid pressure, or midline shift is well known. We report a case of cerebral herniation from intracranial hypotension (so-called paradoxical herniation) secondary to a lumbar puncture 1 month after decompressive hemicraniectomy for a large right hemispheric stroke. CLINICAL PRESENTATION: A 50-year-old woman was transferred to our neurosurgical service for obtundation 4 days after a lumbar puncture to rule out meningitis and 1 month after decompressive craniectomy for a large right hemispheric stroke. INTERVENTION: Eighty grams of mannitol was administered before transfer. On arrival at our hospital, the patient was intubated and a computed tomographic scan was performed. The patient was diagnosed with low-pressure herniation after review of the computed tomographic scan. Rehydration was initiated, and the patient was placed in the Trendelenburg position. She became easier to arouse, but her pupils remained dilated. She experienced a sudden severe cardiac arrhythmia leading to a cardiac arrest. Attempted resuscitation was unsuccessful, and the patient was pronounced dead. CONCLUSION: Lumbar punctures may result in lethal intracranial hypotension in patients after hemicraniectomy and are thus contraindicated unless care is taken to remove the pressure gradient of atmospheric air across the lumbar cistern.- - - - - - - - - - ranking = 1.3333333333333keywords = herniation (Clic here for more details about this article) |
7/16. Acute haemorrhage into a microcystic meningioma leading to cerebral herniation.Low-grade (WHO level I) meningiomas are slow-growing, benign tumours typically presenting with unspecific symptoms (e.g. headache), seizures, cranial nerve compression and neuropsychological symptoms determined by location and size of the lesion. Haemorrhagic onset and sequelae are rare, and have been described infrequently. This is a case of a 50-year-old male presenting with signs of tentorial herniation secondary to hyperacute intratumoural haemorrhage (ITH) into a previously undiagnosed meningioma. Emergency surgical decompression and exstirpation of the lesion helped to achieve a favourable outcome. ITH has been described in all including benign intracranial neoplasms. Factors associated with a higher risk for haemorrhage in meningiomas are discussed. Though haemorrhages associated with meningiomas have been reported, ITH into low-grade meningiomas leading to herniation remains a rarity. Bearers of known lesions and their treating physicians who opt for conservative or delayed treatment should be aware of this remote complication.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
8/16. Symptomatic syringomyelia secondary to clinically obscure infratentorial tumour.The formation of a cervical spinal cord syrinx as a result of an infratentorial mass, even though uncommon, has been reported in international literature. In such cases, syringomyelia is usually asymptomatic, while the tumour-related symptoms and signs predominate. We report a patient with a posterior fossa tumour and secondary syringomyelia. In this patient, syringomyelia symptoms and signs were present, and a cervical spine magnetic resonance imaging (MRI) showed a large cervical syrinx. A more careful clinical examination though, revealed a sub-clinical posterior fossa syndrome and brain MRI revealed a large infratentorial meningioma. A posterior fossa craniotomy was performed, followed by complete tumour resection and almost complete remission of the syrinx and its related symptoms. The authors discuss the role of posterior fossa tumour induced tonsillar herniation in the development of secondary syringomyelia, the mechanisms leading to syrinx formation and the conditions that must be fulfilled for that to happen.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
9/16. Is Chiari I malformation in the aged initiated by mechanical factors? Report of three cases.Three cases in which the signs and symptoms of Chiari I malformation were induced and worsened after the occurrence of supratentorial mass lesions are reported. The symptoms improved markedly after removal of the supratentorial lesions in these cases. In the first case, a meningioma in the right parietal region coexisted with Chiari I malformation. Although the cerebellar ataxia and nystagmus disappeared after tumor removal, decompressive surgery for the malformation was performed because of upper cervical nerve symptoms and the patient recovered completely. In the second case, the symptoms first occurred after a car accident, and a computed tomographic scan revealed not only a subdural hematoma, but also tonsillar herniation due to Chiari I malformation. After evacuation of the hematoma and decompressive surgery on the craniospinal junction, the symptoms disappeared. In the third case, the symptoms of malformation developed gradually with depression and gait disturbance. A meningioma in the left frontal region coexisted with Chiari I malformation. Although the symptoms improved remarkably after tumor removal, decompressive surgery on the craniospinal junction was performed because of upper cervical nerve symptoms, and the patient recovered completely. These clinical findings indicate that a supratentorial mass lesion may provoke the symptoms of Chiari I malformation in the aged.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
10/16. Clinical evaluation of the action of dexamethasone.The antioedematous action of dexamethasone was assessed in 28 patients with supratentorial and infratentorial intracranial tumours and craniocerebral trauma. The criteria of evaluation included the state of consciousness, signs of focal cerebral injury, autonomic disturbances and signs of raised intracranial pressure. The greatest improvement was obtained in patients having intracranial tumours with herniation of the brain stem. In cases of extensive craniocerebral trauma no evident improvement was achieved.- - - - - - - - - - ranking = 0.16666666666667keywords = herniation (Clic here for more details about this article) |
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