Current prognosis in fetal ventriculomegaly.

A review of 51 cases referred for evaluation of fetal ventriculomegaly revealed adequate follow-up data in 40 patients. Three of the fetuses were electively aborted and 37 were delivered. There were no cases of death in utero. Of the 37 infants who were delivered, 26 (70%) were treated with shunt placement for neonatal hydrocephalus. The reasons for nontreatment included: inaccurate diagnosis, resolution of hydrocephalus by the time of delivery, neonatal death, and parental wishes. Survival time in the 26 shunt-treated patients ranged from 5 days to 14 years (average 4.25 years); five of these patients died within the first 2 weeks of life. Among the 26 treated patients, satisfactory cognitive ability was found in 10 (38%). Of the seven surviving nontreated infants, satisfactory cognitive ability was demonstrated in six (86%). Children with myelomeningocele displayed cognitive development similar to that in patients without myelomeningocele. The findings suggest that, of patients with in utero diagnosis of ventriculomegaly, approximately one-half survive (4-year average follow-up interval) and 38% of the survivors treated with shunt insertion have normal cognitive development. No subgroup likely to benefit from in utero treatment of ventriculomegaly was identified. Associated central nervous system or systemic malformations were identified in 26 (70%) of the 37 who came to delivery. This community-acquired series, not collected from a high-risk obstetrical-perinatal service, may reflect the general experience of the neurosurgeon consulting in such cases.

Post-traumatic olfactory dysfunction.

OBJECTIVES: This study demonstrates histopathologic and immunocytochemical changes in the olfactory bulb of a patient with post-traumatic olfactory dysfunction. These results are analyzed in light of current understanding of the pathophysiology of anosmia and dysosmia following head trauma. Emphasis is placed on potential mechanisms of human regeneration and recovery. STUDY DESIGN: The current study documents the history of a patient with the initial complaint of complete anosmia following minor head trauma. Two months after the injury the patient developed persistent, severe dysosmia with debilitating weight loss. Neurosurgical treatment, including removal of the olfactory bulbs and tracts, resulted in permanent resolution of dysosmia. METHODS: Histopathologic and immunocytochemical analysis of the olfactory bulbs was undertaken and compared with age-matched control tissue. RESULTS: Pathological analysis of the olfactory bulb revealed a marked reduction in the number of nerve processes with few intact olfactory glomeruli compared with an age-matched control. Specific immunohistochemical staining for the olfactory neuron-specific protein OMP, however, demonstrated the presence of intact axonal projections between the olfactory mucosa and the bulb. CONCLUSIONS: These results support the hypothesis that post-traumatic anosmia involves, at least in part, damage to peripheral olfactory nerve fibers with histological changes in the olfactory bulb. Potential mechanisms for the development of post-traumatic dysosmia are also discussed.

[Laser microsurgery of meningioma. An analysis of a consecutive series of 164 cases treated surgically by using different lasers]. / La microchirurgie au laser des méningiomes. Analyse d'une série consécutive de 164 cas opérés avec différents lasers.

Over a six years period, 224 laser procedures were performed in our clinic, of these 164 (72%) involved meningiomas of various intracranial and spinal locations; 82 (50%) tumors were located in the posterior fossa, 36 (32%) were suprasellar or parasellar meningiomas: a carbon dioxide laser was used in 56 cases, a double wave length YAG laser in 101 cases, and recently a simultaneous Nd YAG and CO2 combolaser in 7 cases. Complete tumor removal was accomplished in 83% of cases and overall mortality was 3%. We think that microscope guided laser techniques represents a significant advancement in the ability to remove deep situated meningiomas that might prove difficult to extirpate by conventional microsurgery. The advantages of these methods include: 1. reduced brain retraction; 2. the ability to operate with smaller and different exposures; 3. a reduced amount of mechanical manipulation by vaporizing in first the dural attachment; 4. improved operative precision and 5. decreased intra operative blood loss.

Gd-DTPA-enhancement magnetic resonance imaging of the cavernous sinus.

Based upon our experiences with 7 cases and a literature review a survey is provided on the possibilities and limitations of preoperative diagnosis of space-occupying lesions of the cavernous sinus using MRI with Gd-DTPA enhancement. Advantages are, that in many cases arteriography is no longer necessary, and that the diagnostic sensitivity is higher as compared with CT. The pattern of enhancement does not allow for histological distinction among the various lesions.

Tumour resection by stereotactic laser endoscopy.

Recent advances in neuro-imaging have led to the early diagnosis of increasingly smaller and more deeply-seated tumours. Conventional neurosurgical techniques are often not satisfactory to deal with these lesions. The authors describe their preliminary experience with a prototype neuro-endoscope. The technical characteristics of the instrument and description of its use in performing stereotactic laser tumour resection are provided.

Intracranial chondroma arising from the cranial vault: CT and MR appearance.

A case of intracranial chondroma arising from the right parietal bone in a 37-year-old woman is presented. CT and MRI findings as well as the differential diagnosis of the lesion are discussed.

Restoration of useful hearing after microvascular decompression of the cochlear nerve.

This report describes a patient with sudden sensorineural hearing loss who was found to have a megadolichoectasia vertebrobasilar system that appeared to be causing compression of the ipsilateral facial and vestibulocochlear nerves. The patient was treated conservatively for 4 months, during which time no hearing returned. He then underwent microvascular decompression of the affected nerves. At surgery, marked compression of the cranial nerves VII-VIII complex and the pons was observed. Postoperatively, the patient experienced a gradual return of useful hearing. We suggest that vascular compression may be a rare, but treatable, cause of sensorineural hearing loss.