Chordoid glioma of the third ventricle: an ultrastructural study of three cases with a histogenetic hypothesis.

Chordoid glioma is a rare neoplasm occurring in the third ventricle and, as the name implies, having a chordoid appearance. It is currently considered a glial neoplasm of uncertain histogenesis with distinct clinicopathologic features. We report three cases of chordoid glioma with a focus on the ultrastructural appearance. The patients were two men and one woman aged, respectively, 34, 40, and 43 years. Immunohistochemically, all tumors showed strong and diffuse reactivity for glial fibrillary acidic protein and vimentin, whereas immunoreactivity for epithelial membrane antigen and cytokeratin was focal. Ultrastructurally, they showed features of ependymal differentiation for the presence of an apical pole with microvilli and a basal pole characterized, as in normal ependyma, by many hemidesmosomelike structures connecting cell membranes to the underlying basal lamina. Constant features were a submicroscopic cell body zonation (i.e., perinuclear, intermediate, subapical, and apical regions) and the presence of secretory granules. These findings were similar to those described for the secretory ependymal cells of the subcommissural organ, a small structure located in a dorsocaudal region of the third ventricle that undergoes regression after birth in humans. Our observations suggest that chordoid glioma may represent a subtype of ependymoma whose cells resemble the highly specialized ependyma of the subcommissural organ.

Combined isotope ventriculography and lumbar myelocisternography in the diagnosis of communicating syringomyelia. Case report.

Several investigative procedures are currently used to diagnose communicating syringomyelia. The combination of isotope ventriculography and lumbar myelocisternography has never proposed nor carried out to verify this condition. We feel that this is a safe and valuable procedure to identify a patent central canal communicating with the fourth ventricle and is worth considering when diagnosing communicating syringomyelia.

Three years experience with microsurgical technique in treatment of protruded lumbar disc.

The Authors report 120 cases of protruded lumbar disc operated on by microsurgical technique over the last 3 years. The operating technique is summarized and the indications for this type of surgery are discussed. Both immediate and long-term results are reported. Five patients were re-operated on because of recurrence in the same interspace. As the follow-up revealed there were favourable results, regarding especially the disappearance of pain and resumption of working activity. Microsurgical Lumbar Discectomy (MLD) represents an improvement and a valid alternative to standard technique: it enables to remove the disc with a very limited local damage which means a shorter period of convalescence and a better aesthetic result.

Pseudotumor cerebri. Lumboperitoneal shunt in long lasting cases.

The Authors report three cases of pseudotumor cerebri with noteworthy visual defect. Lumboperitoneal shunt enables good recovery where there was no atrophy of the optic nerve and demonstrated its usefulness also in serious situations.

Influence of psychic distress on short-term outcome of lumbar disc surgery.

The authors tried to assess neurotic traits of 19 consecutive patients having micro-lumbar discectomy and to verify the relation between psychic distress and surgical outcome. All subjects had unequivocal clinical and myelographic evidence of lumbar disc herniation. Neurotic distress was measured by Middlesex Hospital Questionnaire (M.H.Q.) and was related to M.H.Q. scores of a control group. Subjective ratings of treatment effectiveness and residual pain, assessed by interview at one month after surgery, were related to psychometric data. Results of statistical analysis provided evidence that although M.H.Q. scores of patients group were different from controls' M.H.Q. scores with regard to the tendency to somatize, psychological disturbances played no role in determining outcome after discectomy. Authors suggest that whenever a reliable diagnosis of herniated disc together with correct operative approach are performed, neurotic mechanisms do not usually affect surgical outcome.

Ossifying parasellar chondroma. Case report.

The Authors report a case of cartilaginous tumor of the parasellar region, diagnosed as ossifying chondroma by virtue of the intense calcification it presented. Preoperative diagnosis was suggested by CT, which showed a characteristic honeycomb conformation, with alternate areas of greater or lesser density, without contrast enhancement. Angiography is, however, essential in planning the operation, which must on occasion be confined to partial resection only. This limitation may be acceptable where functionally important areas are concerned, since these neoplasms show an apparent tendency to only modest growth.

Paretic neurosyphilis and cerebral gumma. Case report.

A rare case of neurosyphilis presenting with dementia paralytica and radiological appearance of cerebral gumma is reported. In accordance with previous comparable reports Authors noticed that diagnosis of this disease actually is still based on serological tests and clinical examination. CT, NMR and Cerebral angiography were not able to provide diagnostic findings, although NMR confirmed its ability to detect lesions not discovered by CT scan. Also findings from stereotactic biopsy only revealed an old not active infection.

Brain stem auditory evoked potentials in early evaluation of cerebral concussion.

In 37 patients brainstem auditory evoked potentials were recorded within 48 hours from a mild head injury. About half of the patients had at least one abnormal neurophysiological parameter pointing to dysfunction of brainstem structure.

Myelography with metrizamide in the study of the lumbosacral tract.

The authors report their experience with Metrizamide (Amipaque) in the myelographic study of the lubosacrale) in the myelographic study of the lumbosacral tract. They compare their results with those obtained with other hydrosoluble contrast agents and correlate them with surgical findings. Metrizamide appears to be preferable to other hydrosoluble contrast agents due to its better radiological definition and because of the lower frequency of complications related to its use.

Intracranial spread of a giant frontal mucocele: case report.

A giant mucocele eroded both the anterior and posterior wall of the frontal sinus and infiltrated the dura mater. Its extracranial growth caused a frontal bony prominence. The tumour and part of the dura were resected. A 12 x 6cm defect in the dura was repaired with a freeze-dried patch. A split-thickness bone graft from the right parietal region was used to repair the anterior frontal bony defect. The result one year later was satisfactory. Spiral computed tomography with thr ee-dimensional reconstructions excluded any recurrence of the tumour and showed good integration of bone grafts.