Conjoined lumbosacral nerve roots: observations on three cases and review of the literature.

Lumbosacral nerve root anomalies are a rare group of congenital anatomical anomalies. Various types of anomalies of the lumbosacral nerve roots have been documented in the available international literature. Generally speaking, these anomalies may consist of a bifid, conjoined structure, of a transverse course or of a characteristic anastomized appearance. Firstly described as an incidental finding during autopsies or surgical procedures performed for lumbar disk herniations and often asymptomatic, lumbosacral nerve root anomalies have been more frequently described in the last years due to the advances made in radiological diagnosis (metrizamide myelography and CT, MRI). Our study comprised three patients with conjoined lumbosacral nerve roots, representing 0.25% of a total of 1200 patients who underwent lumbosacral CT/MRI procedures in the Addolorata Hospital and in the Service of Neuroradiology of the University of Rome "La Sapienza" during the last three years (March 2001-March 2004). We report our experience with three cases of conjoined lumbosacral nerve roots and analyze the most important literature on this topic. MR imaging is a better diagnostic procedure (in comparison to CT) for the differentiation of nerve root anomalies and, in particular, coronal sections furnish a precise definition of the profile of the conjoined/enlarged rootlets. In fact, the accurate information derived from MRI of multiple planes may be priceless for the preoperative and diagnostic evaluation of lumbosacral nerve root anomalies.

Radiological evidence of anatomical variation of the inferior vena cava: report of two cases.

The inferior vena cava (IVC) is a retroperitoneal key structure whose location and integrity must be checked in every scan. A number of studies are reported in the literature concerning congenital variations of the inferior vena cava. Anatomical variations of this main venous trunk are relatively infrequent clinical findings during surgery or diagnostic procedures in patients without symptoms such as an aberrant venous drainage or abdominal pain. Among the other imaging techniques, computerized tomography is a non-invasive, effective technique for diagnosing diseases of the retroperitoneal space and, particularly, for detecting anomalies of the main vessels, such as the aorta or IVC, in asymptomatic patients. We present two cases of IVC variation as an incidental finding in patients studied by means of CT scan for the gradation of kidney carcinoma and pancreatic cancer respectively. Two different configurations of the system of the IVC (agenesis of the IVC with hypertrophy of the azygos vein and a double IVC respectively) were found in our cases. The embryological development of the IVC system is discussed, bearing in mind that knowledge of the different variations is important in order to avoid major surgical complications.

Sphenoidal metastasis from prostate carcinoma. Case report and review of the literature.

A case of an uncommon sphenoidal metastasis from prostate carcinoma with cranial nerve involvement is described. Current concepts of metastatic spread of this tumor to the skull base, clinical signs and therapeutic approaches are reviewed in the light of the available literature.

Solitary metastases to the cranial vault. Report of ten cases.

BACKGROUND: Metastatic spread of tumors to the skull is quite unusual and often represents a relevant diagnostic and therapeutic problem. Skull involvement can be observed in various neoplasms of epithelial origin (rarely in other tumors) and most often responsible are lung, breast, thyroid, kidney and prostate cancers. Less frequent than multiple involvement, single cranial vault lesions are often amenable to surgical resection instead of radiotherapy alone; scope of this paper is to highlight the key points of the management of such entities, including a brief review of the pathological and radiological features of these entities. METHODS: A retrospective study has enabled us to select from our files ten cases of surgically treated solitary cranial vault metastases, with a variable follow-up ranging from 6 months to 4 years. In all the cases the operation consisted in a monobloc resection and a cranioplasty for the repair of the defect. RESULTS: We have observed no perioperative morbidity or mortality; in all the cases surgery allowed histologic confirmation and immediate relief of neurological symptoms and cosmetic impairment (when present). CONCLUSIONS: Monobloc resection of solitary cranial vault metastatic lesions is an easy made and safe procedure, to be performed in every patient except the ones in poor general conditions, which are better addressed to radiotherapy alone.

Advances in diagnosis, treatment and prognosis of intracerebral tuberculomas in the last 50 years. Report of 21 cases.

Intracranial tuberculosis accounts for less than 0.2% of intracranial space-occupying lesions diagnosed and treated in western countries, while it still represents a major neurosurgical finding in underdeveloped countries. The introduction of chemotherapeutic agents for the treatment of tubercular infection, as well as the general improvement in the socio-economic status of the population as a whole, have both played an important role in the dramatic reduction of intracranial tuberculomas in industrialized countries. The increasing migration flow from third world countries, along with other factors, will probably result in increased exposure to such pathologies also in western Neurosurgical centers. A series of intracranial tuberculoma lesions were selected and analyzed, with the aim of pointing out the evolution of diagnosis, treatment and prognosis of such clinical entities throughout the years.

Rathke's cleft cyst: a clinical and radiographic review.

We report the case of a 62-year-old woman, who had a 4-year history of progressive visual acuity deficit. On neurological examination, visual acuity was 5/20 in the right and 4/20 in the left eye. A hormonal study revealed hypophyseal hypofunction. CT and MRI scans showed an intra-suprasellar cystic lesion, hyperintense in T1 and hyperintense in T2-weighted sequences. At surgery, the cyst wall was opened and the cavity placed in communication with the subarachnoid space. Histological examination showed a Rathke's cleft cyst. After four years of follow-up the patient's visual deficit remained unchanged, whereas the results of the hormonal assays were normal. An MRI scan confirmed the absence of the cyst. We review 216 reported cases of Rathke's cyst and discuss its pathogenesis, clinical features and treatment.

Synovial cysts: clinical and neuroradiological aspects.

Lumbar and intraneural synovial cysts are uncommon lesions, although their incidence has increased since the introduction of MRI. The authors describe the results of a study comprising 23 patients with synovial cyst (5 lumbar, 19 intraneural). Neuroradiological investigations included CT scan and MRI; however, it was not always possible to diagnose the nature of the lesion. In 18 cases the lesion was removed totally including its capsule; in the other 5 cases it was removed subtotally. Seven of the 23 patients presented a total remission of symptoms/signs, 11 improved and 5 remained unchanged. The importance of treating synovial cysts as radically as possible is discussed together with their most significant clinical and neuroradiological aspects.

Development of intracranial meningiomas at the site of cranial fractures. Remarks on 15 cases.

The authors present a retrospective study of 15 patients with post-traumatic intracranial meningioma. The 15 cases were selected according to the criteria specified in the relevant literature. Assessment of clinical characteristics in these patients seems to confirm that in some cases head trauma may be a factor contributing to the development of meningioma.

Solitary cerebral metastasis from lung cancer with very long survival: report of two cases and review of the literature.

Solitary cerebral metastases from lung cancer are not uncommon clinical events. Whatever treatment is adopted, long-term survival is rare. Very rare indeed are reports of patients surviving the discovery of lung cancer and brain metastasis for 10 years or more. Indeed, only 16 cases have been reported to our knowledge. We report two further cases, stressing the importance of correct clinicopathological staging so that treatment may be conducted in the way most likely to ensure longer and better survival and, pending a therapeutic breakthrough, to increase the number of long-term survivors.