Assuntos
Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico , Meningioma/cirurgia , Neurocirurgia/métodos , Seios Transversos/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Primary cranial chondrosarcoma in an uncommon cartilaginous tumours of which the myxoid variant is the least reported in the literature. This tumour accounts for 0.15% of all primary intracranial lesions and 6% of all skull base tumours. Chondrosarcomas are frequently misdiagnosed as chordomas, which have a different prognosis. Differential diagnosis is very important because, when treated with similar aggressive treatment strategies, chondrosarcoma has a much better prognosis than chordoma. We describe a 54-year-old female with a 9-month history of left ophtalmoplegia and increasing headache. MR imaging of the head showed a sellar and left parasellar mass. We performed a gross total removal of the mass via a left pterional approach. The histopathologic diagnosis was of a myxoid chondrosarcoma. A post-operative contrast-enhanced computed tomography (CT) scan of the head showed a total removal of the neoplasm. After surgery, the patient showed a transitory dysphasia with right hemiparesis, but they both considerably improved before discharge. Review of the literature was identified using the Medline database: only 10 cases in the worldwide literature were identified to report on this kind of tumour. We present a case report of myxoid chondrosarcoma, a rare variant of chondrosarcoma, with sellar and left parasellar localization. This histopathological type is a low-grade variant and its total removal is effective.
Assuntos
Condrossarcoma/cirurgia , Neoplasias da Base do Crânio/cirurgia , Condrossarcoma/diagnóstico , Condrossarcoma/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Neoplasias da Base do Crânio/diagnóstico , Neoplasias da Base do Crânio/patologiaAssuntos
Neoplasias Encefálicas/cirurgia , Neoplasias do Ventrículo Cerebral/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Ventrículos Laterais/cirurgia , Meningioma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Ponte/cirurgia , Neoplasias Encefálicas/patologia , Neoplasias do Ventrículo Cerebral/patologia , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Humanos , Ventrículos Laterais/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/patologia , Ponte/patologia , Resultado do TratamentoRESUMO
Chronic subdural hematoma (CSDH) is a common pathology in the elderly but very rare in young adults. When CSDH occurs in this age group, severe head injury or some promotive factors are usually present. This article reports the case of a 29-year-old female presented at our Emergency Department with a few days' history of progressive frontal headache. Computed tomography scan of the head showed a right frontal CSDH. Only a decreased level of consciousness without focal deficits was present at clinical examination and her medical history was negative for trauma or promotive factors. Blood count showed a mild sideropenic anemia while coagulation tests were normal. No vascular malformations were shown at digital subtraction angiography. The patient underwent craniotomic evacuation. After surgery, the patient showed a full neurological recovery. Spontaneous CSDH in young adults is very rare. In the worldwide literature, many cases of non-traumatic CSDH are reported, but a promotive factor is generally present. We described a case of spontaneous CSDH, whose etiology remains unknown.
Assuntos
Craniotomia , Hematoma Subdural Crônico , Tomografia Computadorizada por Raios X , Adulto , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Recuperação de Função FisiológicaRESUMO
Osteoblastoma (OB) is a rare primary benign bone tumor. It generally occurs in the axial skeleton, where it preferentially involves the neural arch. The peak incidence of this neoplasm is in the first two decades of life. Female/male ratio is 2:1. It is important to differentiate OB from osteoid osteoma, a very similar bone tumor. Neuroradiological imaging are diagnostics in most of the cases. This article describes a 18-year-old female affected from a thoracic osteoblastoma stemming from T9 lamina and extending to T11, with a diameter of about 2.5 cm. The patient complained of dorsal pain with progressive weakness to lower limbs. A dorsal approach was performed with a right partial T9 and T11 right laminectomy with total T10 right laminectomy. The mass was totally removed by a limited approach, with no consequent instability and no reason for any stabilization. OB is rare benign bone neoplasm that generally affect the posterior elements of the spine. Surgery is the treatment of choice in this kind of lesions: total removal is effective with no recurrence. When the lesion is placed in the cervical and thoracic spine the goal is to decompress spinal cord and reach the stability of the spine.
Assuntos
Procedimentos Neurocirúrgicos/métodos , Osteoblastoma/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Dor nas Costas/etiologia , Descompressão Cirúrgica/métodos , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/patologia , Espaço Epidural/cirurgia , Feminino , Humanos , Laminectomia/métodos , Osteoblastoma/diagnóstico por imagem , Osteoblastoma/patologia , Paraparesia/etiologia , Canal Medular/diagnóstico por imagem , Canal Medular/patologia , Canal Medular/cirurgia , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Medula Espinal/cirurgia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
AIM: The aim of this study was to evaluate the results of a consecutive series of 16 patients affected by degenerative cervical spondylosis and operated on by anterior cervical discectomy and fusion (ACFD) by means of anterior bioresorbable plate and screws. Further, the authors compared the results in these patients with a series of 13 patients also affected by degenerative cervical spondylosis in whom arthrodesis was obtained by means of cages without plates.\ METHODS: The series included 8 males and 8 females aging from 37 to 69 years, operated from June 2003 to September 2004. They showed signs of cervical myelopathy, radiculopathy or both. The ACDF was performed with the insertion of dense cancellous allograft and application of anterior bioresorbable plate and screws (group A). The group B series included 9 males and 4 females aging from 50 to 77 years, all affected by the same pathology of group A patients and operated on in the same period of time. In these cases the ACDF was followed by the insertion of cages without anterior plates. RESULTS: The retrospective analysis of our series showed lack of soft tissue reaction, with safeguarding of the vertebral body and disc space height. The degree of alignment of the cervical spine was also preserved, with a good rate of fusion and a good clinical outcome in both series of patients. CONCLUSION: The use of a cervical plate increase stability and rate of fusion when added to the interbody device; while the use of a metallic plate may be responsible for several shortcomings, a resorbable plate may overcome these problems.
Assuntos
Implantes Absorvíveis/estatística & dados numéricos , Vértebras Cervicais/cirurgia , Osteofitose Vertebral/cirurgia , Implantes Absorvíveis/normas , Adulto , Idoso , Materiais Biocompatíveis , Placas Ósseas/normas , Placas Ósseas/estatística & dados numéricos , Parafusos Ósseos/normas , Parafusos Ósseos/estatística & dados numéricos , Vértebras Cervicais/patologia , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Disco Intervertebral/patologia , Disco Intervertebral/fisiopatologia , Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Radiculopatia/patologia , Radiculopatia/fisiopatologia , Radiculopatia/cirurgia , Estudos Retrospectivos , Osteofitose Vertebral/patologia , Osteofitose Vertebral/fisiopatologia , Estenose Espinal/patologia , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia , Resultado do TratamentoRESUMO
A total of 73 patients underwent microdiscectomy for lumbar disc herniation between September 2001 and May 2002 at the Department of Neurosurgery of the Second University of Naples. Preoperatively and 3 and 6 months after surgery, patients were assessed on the Zung Self-rating Depression Scale (SDS) and on a visual analogue scale (VAS) for the subjective perception of pain. At 3 and 12 months, we found that patients with lower SDS scores (n=41) had a better outcome regarding pain than patients with relevant depressive symptoms (n=32). In agreement with the literature, our results confirm the negative role of depression in outcome after lumbar disc surgery. We emphasize the consideration of psychological factors in the management of lumbar disc herniation.
Assuntos
Depressão/diagnóstico , Depressão/psicologia , Discotomia/psicologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/psicologia , Adolescente , Adulto , Idoso , Análise de Variância , Discotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor/psicologia , Medição da Dor/estatística & dados numéricos , Prognóstico , Análise de RegressãoRESUMO
Recent studies suggest that different subtypes of receptors may mediate the action of various bombesin-related peptides in different tissues. In the present study the ability of bombesin and its structurally related peptides [litorin, gastrin-releasing peptide (GRP), GRP18-27, neuromedin B, [Leu8]litorin, and bombesin nonapeptide BN(6-14)] to interact with smooth muscle cells isolated from guinea pig stomach was investigated. Each peptide induced a specific contractile response with potencies (D50 in pM) of [Leu8]litorin (0.7) greater than bombesin (1.2) greater than litorin (3) greater than neuromedin B (3.5) = GRP (3.8) = GRP18-27 (3.9) greater than BN(6-14) (70.9). The specific bombesin receptor antagonist psi 13,14-bombesin differed in its potency for inhibiting equipotent concentrations of bombesin, GRP, or neuromedin B, was equipotent for bombesin or GRP (IC50 12.7 and 22.1 nM), and was 11 times less potent for neuromedin B (IC50 234.5 nM), suggesting the presence of subtypes of receptors mediating the action of bombesin-related peptides. To further investigate this possibility, a technique of receptor protection that enables selective preservation of one receptor type was used. GRP or bombesin protected completely the response to GRP or bombesin but abolished the subsequent contractile response to neuromedin B. Neuromedin B, instead, protected only the response to neuromedin B. These results demonstrate that gastric smooth muscle cells possess specific receptors that interact with bombesin-related peptides and that two receptor subtypes mediate the contractile response to these peptides: one subtype is selective for bombesin or GRP, the other for neuromedin B.