Gunshot injuries to the brachial plexus during wartime.

Gunshot injuries of the brachial plexus are a challenging issue among peripheral nerve lesions. Surgical reconstruction of such injuries is difficult and the clinical outcome depends on several factors. The aim of this study was to present the outcome of surgical management of gunshot injuries of the brachial plexus that occurred following Iran-Iraq war. Twenty patients with 55 injured elements of the brachial plexus underwent surgery in Loghman-Hakim Hospital during 1982 and 1992. Reconstructive procedures included neurolysis in 30 injured elements, nerve grafting in 17 and a combination of these two methods in 8 cases. Surgical procedure was selected based on the microscopic findings during the operation. Final recovery outcome was assessed at least 3 years after surgery on the basis of motor and sensory recoveries. Final outcome was defined as poor, intermediate, and good. Both good and intermediate outcomes were considered as useful recovery. An acceptable recovery was obtained in 28 of 30 (94%) injured elements undergone neurolysis, 15 of 17 (89%) elements in nerve graft group, and 7 of 8 (87.5%) elements reconstructed with neurolysis in combination with nerve graft. In neurolysis, good recovery was more frequent and obtained in 23 of 30 (77.5%) lesions. Best treatment outcome was observed in lesions of lateral cord to musculocutaneous nerve which all injured elements showed good recovery. Impairment in none of the lesions in the level of posterior cord and lower trunk or C8-T1 led to good recovery. In surgical reconstruction of gunshot injuries of the brachial plexus the most favorable results were observed in the neurolysis reconstruction of the lesions in the lateral cord to musculocutaneous nerve. In the absence of spontaneous improvement of neurologic deficit, surgical procedures should be done as soon as possible according to the type and location of injury.

Endoscopic transrostral- transsphenoidal approach to petrous apex cholesterol granuloma: case report.

Cholesterol granuloma (CG) of the petrous apex is an inflammatory reaction to the by-products of eroded marrow cavities secondary to chronic obstruction of air cells within the petrous pyramid. We report a case of cholesterol granuloma in the left petrous bone occurring in a 28-year-old woman with an unusual presentation. The woman presented with a 6-month history of intermittent left hemicranial headache and diplopia. CT scan of petrous bone and skull base showed an expansile mass of the left petrous apex. For surgical removal we used the transrostral transsphenoid approach. After surgery, all the symptoms and signs of the patient completely recovered. In this report, the indications and merits of the endoscopic transsphenoidal drainage procedure are illustrated through a case presentation.

Angiosarcoma of skull in a pregnant woman: case report and review of the literature.

Angiosarcoma is a rare tumor of bone that uncommonly involves the skull. Primary neoplasms of the skull represent 2.6% of primary neoplasms of bone. We wish to report a case of angiosarcoma of he skull in an 18-year-old pregnant woman who presented with a rapidly growing left frontotemporal mass. Neuroimaging revealed a left frontotemporal mass with destruction of diploic space and both tables and with extension to the subgaleal and epidural spaces. The patient underwent surgery and the tumor was removed totally. Histological features of angiosarcoma were seen in the pathology study. She received adjuvant chemotherapy and radiation therapy. She has remained well during 6 years of follow-up with no evidence of recurrence. Angiosarcoma is a rare malignant bone tumor of vascular origin. Our case is the only female patient with skull angiosarcoma that has been reported so far.

Transcranial approach for spontaneous CSF rhinorrhea due to Sternberg's canal intrasphenoidal meningoencephalocele: case report and review of the literature.

One type of congenital intrasphenoidal meningoencephalocele is remnant of lateral craniopharyngeal (Sternberg's) canal. We present a case of a 23-year girl with 10-month history of right side CSF rhinorrhea. CT scan, MRI revealed congenital meningoencephalocele and CSF leak from middle fossa to right side of sphenoid sinus, and there were bony defects at the floor of the anterior aspect of the right middle fossa. Transcranial repair was performed with right side pterional craniotomy. Careful preoperative evaluation and localization of the sphenoid defect are essential for selection of the best possible surgical approach and skull base reconstruction for repair of sphenoid sinus CSF leaks and meningoencephaloceles. In this case, an endoscopic technique was not successful so, transcranial repair was performed with right side pterional craniotomy.

The anatomical relation between the superior sagittal sinus and the sagittal suture with surgical considerations.

OBJECTIVE: Localization of superior sagittal sinus before craniotomy is very crucial to prevent the complications of surgery. The goal of this study was to verify the anatomical relationship between the sagittal suture and the superior sagittal sinus (SSS). METHODS: Fifty adult cadavers were included in this descriptive analytic study. The length of sagittal suture and the width of sagittal suture and SSS were measured in three points: (bregma), (lambda) and midpoint of sagittal suture. Anatomical relationship between SSS and sagittal suture was analyzed. RESULTS: Superior sagittal sinus was deviated to the right side of the sagittal suture in 54% of cases at bregma and 64% of cases at the midpoint of sagittal suture and lambda. SSS was located at the right side of sagittal suture about 3.5mm at bregma, 4.5mm at midpoint of sagittal suture and 5.7 mm at lambda. The right transverse sinus was dominant in 76% of cases. No gender-associated difference was noticed. CONCLUSION: Our study demonstrates that SSS is deviated to the right side of sagittal suture in the majority of cases. Maximum deviation of SSS to the right side is about 10mm. Neurosurgeons are advised to be aware of this anatomical relation while operating around SSS.

Isolated, primary spinal epidural Hodgkin's disease in a child.

A 12-year-old boy presented with backache and bilateral progressive lower extremity weakness. Radiological examination revealed a mass on the epidural space at level L(1)-L(3). The patient had laminectomy and posterior decompression. Histopathology examination revealed lymphocyte dominant type Hodgkin's disease. All other investigations (including computed tomography of the chest and abdomen, bone scan, gallium scan, bone marrow aspiration, and cerebrospinal fluid study) were negative for occult disease. The patient received combined therapy with irradiation and chemotherapy after surgery. At 7 years after the diagnosis, he had remained disease free and with normal functional status. This patient represents a rare case of primary epidural Hodgkin's disease in the lumbar region, rare also for onset in childhood.