From surgery to neurosurgery: our experience on the efficacy of fleece-bound sealing (TachoSil®) for dural repair.

AIM: To report on our routine use of TachoSil® for dural repair in neurosurgical practice. METHOD: TachoSil® has been applied in different fields of surgery thus far. When using TachoSil®, fibrinogen and thrombin is provided locally at the site of the dural defects. Upon contact with fluid, the clotting factors of TachoSil® dissolve and form a fibrin network, which glues the collagen sponge to the wound surface. RESULTS: In our experience, TachoSil® was found to be effective as support for the suture of the dura in patients undergoing spinal and cranial neurosurgical operations. Two illustrative examples are shown. CONCLUSIONS: Our procedure showed that closing the dural defect with TachoSil® is a technically simple, reliable and safe method for patients. Indeed, no post-operative cerebrospinal fluid leakage was observed. Nonetheless, further studies with larger sample size are warranted to confirm the efficacy of TachoSil® patches for dural repair.

Benefit of surgery in presence of orbital metastasis.

PURPOSE: Malignant tumors metastatic to the orbit are rare and only about 5% of orbital tumors are metastasis. We report on orbital surgery in a patient with orbital metastasis from small cell lung carcinoma (SCLC). METHODS: A 75-year-old man complained of pain in the left orbital region and proptosis. Head CT scan showed a left retrobulbar mass compressing the optical nerve. Chest and body CT scans showed a round-shaped mass at the apex of the left inferior lobule of the lung and widespread nodal involvement. RESULTS: A surgical intervention on the left orbit through a lateral approach was performed, with complete removal of the mass. Histology showed features of a non-anaplastic SCLC. A complete restoration of visual acuity was obtained CONCLUSIONS: A debulking orbital surgery, in order to relieve optic nerve compression, should be offered to the patients with orbital metastasis.

Prevention of post-operative infection in spine surgery by wound irrigation with a solution of povidone-iodine and hydrogen peroxide.

Starting from January 2008, we systematically irrigated the surgical wounds of patients undergoing spine surgery with a solution of povidone-iodine and hydrogen peroxide. We prospectively recorded the clinical data of patients who underwent spine surgery during 2008 and we compared the results with retrospectively reviewed clinical records of patients operated during 2007. Patients were analyzed for preoperative risk factors, type of surgical procedure, onset of infection, presentation, treatment and outcome. We performed 490 spine surgeries during 2008 and 460 during 2007. We recorded four postoperative infections in 2007 compared to none in 2008. We consider this solution of povidone-iodine plus hydrogen peroxide effective to further reduce the rate of post-operative infection in spine surgery.

Supero-lateral orbitotomy for resection of spheno-orbital meningioma: a case report.

Spheno-orbital meningioma have traditionally been defined as secondary tumors of the orbit originating from the dura of the sphenoid wing bone. Nevertheless, pathologic findings reveal a distinct periorbital component as a defining feature of these lesions. These tumors are characterized by an intraosseous mass growth leading to a significant hyperostosis involving the sphenoid wing, the orbital roof, the lateral orbital wall and the middle fossa cranial base and to a thin, usually soft-tissue growth at the dura. We report here on the extension of the primary tumor into the orbital cavity and present the surgical approach performed.

Papillary glioneuronal tumor of the fourth ventricle: case report and review of the literature.

Rosette-forming glioneuronal tumour (RGNT) of the fourth ventricle is a relatively new entity recently described. Neuronal and mixed neuronal-glial tumours have been incorporated in the same category in the WHO Classification of Nervous System Tumours. This category comprises heterogeneous neoplasms composed of neuronal and glial cells with various grades of differentiation. We present a case of papillary glioneuronal tumor occurring in a 44-year-old man with an unusual hemorrhagic onset. The clinical, morphological and immunohistochemical features are discussed and the published literature is reviewed.

X-Stop interspinous implant for the treatment of lumbar spinal stenosis. Our experience after 50 consecutive patients.

The authors report their surgical experience on 50 patients affected by single or two level segmental lumbar canal stenosis who underwent implantation of one or two X-Stop interspinous devices between October 2007 and February 2008 at the Department of Neurosurgery, "Santa Maria alle Scotte" Hospital, Siena, Italy. In the present study there will be analyzed clinical long-term results and reviewed the relevant literature.

Protective wrapping of the ulnar nerve in severe cubital tunnel syndrome: treatment and long-term results.

The authors report their surgical experience with 10 cases of anterior subcutaneous ulnar nerve transposition and coverage of the nerve with substitutive dural flap, performed between January and November 2008 at the Department of Neurosurgery ("Santa Maria alle Scotte" Hospital, Siena, Italy) in the treatment of severe cubital tunnel syndrome. Clinical long-term results are analyzed and the relevant literature is reviewed.

Retinal detachment and convexity intracranial meningioma: an uncommon association.

CASE REPORT: A 70-years-old woman presented with a one week history of progressive loss of vision in the right eye (RE) diagnosed as retinal detachment from 7 to 1 o' clock with retinal break at the 10.30 o' clock associated. Gadolinium enhanced magnetic resonance imaging (MRI) scan of the brain and orbits with fat suppression showed a convexity meningioma. Scleral buckling with a segmental sponge, subretinal fluid drainage and cryopexy were performed with detachment repair. CONCLUSION: In our patient with retinal detachment and convexity meningioma without significant neurological symptoms, performing ocular surgery and close follow up care seemed to be the optimal treatment option.

Pterygomaxillary extension of orbital pseudotumor. Case report.

Idiopatic pseudotumor (IP) is a non-specific, non-neoplastic, inflammatory process without identifiable local or systemic causes. IP most commonly affects the orbit, comprising 5% to 8% of all orbital masses with occasional extension to other areas of the skull base. The ophthalmology literature has detailed reviews of IP as a space-occupying intraorbital lesion, but lesion involving only the skull base and sparing the orbit is exceptional. Understanding the presentation, work-up, and characteristics of the lesion is important for proper diagnosis and treatment. We report a rare case of orbital IP with extension into infratemporal fossa. Clinical and radiological findings and surgical approach are discussed.

Long-term effectiveness of lumboperitoneal flow-regulated shunt system for idiopathic intracranial hypertension.

AIM: The aim of the study was to assess the efficacy of lumboperitoneal flow-regulated shunt for the treatment of idiopathic intracranial hypertension (IIH). METHODS: This was a retrospective study carried out on four patients with IIH, treated from January to December 2007 with lumboperitoneal flow-regulated shunt (OSV II Smart Valve Systems; Integra NeuroSciences). The mean follow-up period was 13 months. RESULTS: The treatment was successful in alleviating symptoms in all cases and no patient required revisions. CONCLUSIONS: In conclusion the placement of flow-regulated valves is a satisfactory treatment for those IIH patients who require surgical therapy.

Spinal epidural hematoma following epidural anesthesia. Case report.

Epidural anesthesia is one of the preferred modes of analgesia intra- and postoperative in limb surgery. Although considered very safe, serious complications can occur with 0.1-1 per 10,000 epidural injections. We present a case of a patient who experienced an acute lumbar epidural hematoma after epidural anesthesia.

Intracerebral haematoma following spinal anaesthesia for caesarean section: case report.

Several complications are known to occur with spinal anaesthesia and all of them are easily recognizable. We report the case of a 25 year old woman presenting with intracerebral hemorrhage secondary to spinal anaesthesia for caesarean section. She underwent surgical evacuation of the haematoma with complete recovery. The relevant literature is also reviewed.

Benign orbital pseudolymphoma. Case report.

Orbital pseudolymphomas are uncommon benign tumors composed of reactive lymphocytes. The typical clinical presentation is painless onset of ptosis, proptosis, diplopia, or eyelid swelling. Virtually any adnexal structure can be affected, but lacrimal gland, orbital soft tissue, or extraocular muscles are the usual sites of involvement. Historically, treatment has been with oral corticosteroids or localized radiotherapy. We present a case of benign orbital pseudolymphoma.

Transmanubrial osteomuscolar sparing approach for T1-T2 thoracic disc herniation.

Herniated thoracic disks are rare entities and their surgical treatment comprises 0.15% to 4% of all disk operations. Surgical approaches have included pediculectomy, costotransversectomy, lateral extracavitary, transthoracic thoracotomy, and thoracoscopy. The authors present a transmanubrial osteomuscular sparing approach for the treatment of T1-T2 thoracic disc herniation that is likely to be the only one described in the literature for this disease so far.

Solitary Langerhans cell histiocytosis orbital lesion: case report and review of the literature.

Solitary eosinophilic granuloma is a rather benign and localized form of Langerhans's cell histiocytosis. Definitive diagnosis is made by histopathology including immunohistochemical detection of S-100, HLA-DR and CD1a antigens. We report the case of a twenty-five year old boy presented with headache and orbit's pain. A CT scan showed a left supero-lateral orbital mass with evidence of bone erosion. The different options of treatment are discussed and the literature is reviewed.

New classification of rating facial nerve dysfunction.

In consideration of the complexity of the physiopathology of the facial nerve and to get a standard model of classification of his dysfunction, it appears evident the necessity in the clinical practice to have a rapid, simple and easy system. Grading of facial function is necessary for evaluating and communicating the spontaneous course and the results of medical and surgical treatment. Different grading scales have been proposed but none has been universally accepted; the author revises the principal systems of classification and proposes a new and easy model.

Intracerebral haemorrhage following surgical evacuation of chronic subdural haematoma: case report.

Intracerebral haemorrhages occurring after removal of chronic subdural haematoma have been reported as a rare but nearly uniformly devastating postoperative occurrence with incidence ranges between 0,7 and 5%. The absence of a particular attention paid to such complication in literature prompted us to present this report adding our personal experience to the cases already described in the literature.

A case of Capnocytophaga canimorsus brain abscess secondary to dog's bite.

Capnocytophaga canimorsus has been recognized as an opportunistic pathogen causing systemic infections in immunocompromised individuals. It is part of the normal oral flora of the dog, and can be responsible for localized wound infections in humans in consequence of bites. This microorganism causes also septicemia, meningitis, endocarditis, ocular infections and rarely brain abscess. We describe the case of an immunocompetent 28-year-old male with temporal brain abscess from Capnocytophaga canimorsus secondary to dog's bite.

Involvement of electrophysiological localization of the subthalamic nucleus in deep brain stimulation for Parkinson's disease.

We studied the involvement of the electrophysiological localization of the subthalamic nucleus (NST) using a multi-unit recording technique by means of semi-microelectrode in a set of thirty Parkinson's patients who benefited from a bilateral stimulation of the NST and who were operated on under local or general anesthesia. The multi-unit recording technique by means of semi-microelectrodes appeared efficient, capable of improving the localization of the NST and leading to improvement in clinical results. We believe that the use of our technique will allow for time savings while providing good results, and that the choice of the angle of the trajectory will allow for improved localization of the NST and thus improved clinical results.

Brain abscess and Rendu-Osler-Weber disease. Case report and review of the literature.

The case of a 51-year-old man presented with intermittent diplopia, headache and family history of Rendu-Olser-Weber disease , also defined heredirary hemorrhagic telangiectasia (HHT), is described. Magnetic resonance imaging of the brain revealed an enhancing right occipital mass with surrounding edema. Computerized tomography of the chest identified pulmonary arteriovenous fistlae. The physiopathology of HHT and the treatment of the cerebral lesions are discussed.