Difficulties in treatment of CSF leakage associated with a temporal meningocele.

Temporal meningocele is a rarely encountered pathology. It is caused by communication between the subarachnoid space of the middle fossa and lateral extension of the sphenoid sinus. Cerebrospinal fluid (CSF) pressures and the hydrostatic pulsatile forces may lead to the development of pitholes on the middle fossa at the sites of arachnoid villi with herniation of dura/arachnoid or brain tissue into the sinus. We describe an adult patient who presented with spontaneous CSF rhinorrhea due to a temporal meningocele. She was first operated on transsphenoidally, but the CSF rhinorrea did not cessate, therefore she was operated transcranially five days after the first operation. There has been no CSF rhinorrhea for three and a half years. Transcranial temporal encephalocele repairment is more effective than transsphenoidal surgery. Recurrent CSF leaks can occur due to both the increased CSF pressure and the insufficient operation technique.

Cervical lipomyelomeningocele: case illustration.

Cervical lipomyelomeningocele is a rare congenital spinal pathology. Lipomyelomeningocele is the commonest cause of congenital tethering, which causes neurological deterioration due to the conus medullaris and root ischemia. Early intervention is recommended even in cases with normal neurological examinations in order to prevent deterioration but our patient with cervical lipomyelomeningocele had a normal neurological examination despite his age (22 year-old) and had no urodynamic dysfunction.

Lumbar epidural hematoma following lumbar puncture: the role of high dose LMWH and late surgery. A case report.

Spinal epidural hematoma (SEH) is a known complication of spinal surgery, but the incidence of post-surgical SEHs that result in neurologic deficits is extremely rare (0.1%). Patients that require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk of developing an epidural hematoma. The introduction of higher dose of low molecular weight heparin (LMWH) twice daily 30 mg regimen) increased the reported incidence of neuroaxial hematomas. Surgery performed within 8 hours makes good or partial recovery of neurologic function. Our patient was also started on higher dose of LMWH and developed neurological deficits due to a SEH following lumbar puncture. She underwent operation after six days and she had a mild recovery following the operation. Current administration of high doses of LMWH can cause SEH even after a lumbar puncture, which was performed without multiple attempts. Although surgery performed within 8 hours makes good or partial recovery of neurologic function, laminectomy and epidural hematoma evacuation performed after three days can also have successful results.

Bilateral abducens nerve palsy following ruptured anterior communicating artery aneurysm: report of 2 cases.

Isolated abducens nerve palsies associated with intracranial aneurysms have rarely been reported. Their association with anterior communicating artery (ACoA) is even rarer. Intracisternal clot formation and elevated intracranial pressure has been proposed to be the responsible mechanisms. Herewith, we report two cases of bilateral abducens palsies following ruptured ACoA aneurysms and speculated the possible mechanisms. Opening of Liliequist's membrane provides clinical improvement due to CSF release.

Ganglioglioma with lytic skull lesions: a case report.

Gangliogliomas represent only 0.4% of central nervous system neoplasms and 1.3% of brain tumors. They are benign neoplasms with low morbidity and mortality and the patients usually present with seizures, but there has been no adult ganglioglioma with lytic skull lesion. A 49-year-old right handed woman suffering from generalized epileptic seizures was admitted to our hospital. She had also left hemiparesis with 4/5 motor strength. Magnetic resonance imaging and immunohistochemical studies revealed WHO Grade II ganglioglioma. Skull X-ray showed the lytic skull lesions. We have to consider gangliogliomas in the differential diagnosis of lytic skull lesions.

Primary spinal cord oligodendroglioma. Case illustration.

Spinal cord oligodendrogliomas are rare pathologies of the spinal cord, and their location at conus and/or filum terminale is even rarer. There are only 7 spinal cord oligodendrogliomas reported in the literature. Our case is the eighth spinal cord oligodendrogliomas at this location.

Medial microsurgical approach to the orbit: an anatomic study.

The authors have identified and described three medial approaches to the intraorbital portion of the optic nerve in cadavers. The structures exposed via the superior, inferior or central approaches were approached through the medial orbital wall. The superior approach in which the medial rectus muscle is retracted inferiorly exposes the superomedial aspect of the orbit. The inferior approach in which the medial rectus muscle is retracted superiorly, provided the inferomedial aspect of the optic nerve from the globe to the muscle cone. The central approach in which the ethmoidectomy was performed and the medial rectus muscle was disinserted and retracted, provided excellent exposure of the structures of the medial part of the orbit and the optic nerve. There were no structures blocking access to the two third anterior optic nerve and medial surface of the globe. The structures encountered in these approaches are demonstrated under magnification in cadavers, and the exposure of the optic nerve is discussed.

Spontaneous regression of cervical disc herniations.

The spontaneous regression of cervical disc herniations is a rare occurrence. Six herniated cervical discs that had regressed spontaneously are presented. All radiological disc regressions correlated well with clinical improvements. We want to underscore the potential for regression that should be considered in the evaluation and management of any patient with a herniated cervical disc.

Ochronosis and lumbar disc herniation.

Alkaptonuria is a rare, autosomal recessive metabolic disorder in which the homogentisic acid oxidase activity is absent. Its incidence is as low as 0.001%. Ochronosis is the pigmentation of connective tissues and this pigmentation leads to degenerative changes in alkaptonuric patients. Alkaptonuria most prominently involves the lumbar region, but lumbar disc herniation as the presenting feature of alkaptonuria is not common. Only a few patients required surgical intervention. Herewith we report an alkaptonuric patient, who was operated on for lumbar disc herniation. His discectomy material was black and the metabolic disorder was diagnosed retrospectively. This metabolic disease is often recognized on physical re-examination after the black disc material was seen during the operation. Therefore urinalysis for homogentisic acid should be performed in all patients with degenerative changes of the vertebral column. The results of disc surgery in this patient group is successful.

Cervical lipomyelomeningocele: case Illustration

El lipomielomeningocele cervical es una patología raquídea congénita rara. El lipomielo meningocele es la causa más frecuente de anclaje medular, que da lugar a deterioro neurológico, debido a isquemia del cono medular y de las raíces. Se recomienda la intervención precoz, incluso en casos con examen neurológico normal, con el fin de prevenir un deterioro, pero nuestro paciente con lipomielomeningo cele cervical tenía un examen neurológico normal, a pesar de su edad (22 años) y no tenía ninguna disfunción urinaria

Cervical lipomyelo meningocele is a rare congenital spinal pathology. Lipomyelo meningocele is the commonest cause of congenital tethering, which causes neurological deterioration due to the conus medullaris and root ischemia. Early intervention is recommended even in cases with normal neurological examinations in order to prevent deterioration but our patient with cervical lipomyelomeningocele had a normal neurological examination despite his age (22 year-old) and had nourodynamic dysfunction

Lumbar epidural hematoma following lumbar puncture: the role of high dose LMWH and late surgery. A case report

El hematoma espinal epidural (HEE) es una complicación conocida en la cirugía espinal, pero la incidencia del HEE que da lugar a déficit neurológico es muy rara(0,1%). Los pacientes que necesitan intervenciones en varios niveles lumbares y/o que tienen una coagulopatía preoperatoria tienen un riesgo significativamente mayor de desarrollar un hematoma epidural. La introducción de dosis altas de heparina de bajo peso molecular(HBPM), (30 mgrs. dos veces al día) aumentan la incidencia de hematomas neuroaxiales. La cirugía llevada acabo dentro de las 8 horas da lugar a un recuperación buena o parcial de la función neurológica. Nuestro paciente fue tratada con dosis altas de HBPM y desarrolló un déficit neurológico debido a un HEE, después de una punción lumbar. Fue operada al cabo de seis días y se recuperó parcialmente de su déficit después de la intervención. La administración actual de dosis altas de HBPM puede dar lugar a HEE, incluso después de una punción lumbar, que se hizo en pocos intentos. Aunque la cirugía realizada en las primeras 8horas produce una recuperación buena o parcial, la laminectomía y evacuación del hematoma llevada acabo después de tres días también puede dar lugar a buenos resultado

Spinal epidural hematoma (SEH) is a known complication of spinal surgery, but the incidence of post-surgical SEHs that result in neurologic deficits is extremely rare (0.1%). Patients that require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk of developing an epidural hematoma. The introduction of higher dose of low molecular weight heparin (LMWH) twice daily 30mg regimen) increased the reported incidence of neuroaxial hematomas. Surgery performed within 8 hours makes good or partial recovery of neurologic function. Our patient was also started on higher dose of LMWH and developed neurological deficits due to a SEH following lumbar puncture. She underwent operation after six days and she had a mild recovery following the operation. Current administration of high doses of LMWH can cause SEH even after a lumbar puncture, which was performed without multiple attempts. Although surgery performed within 8 hours makes good or partial recovery of neurologic function, laminectomy and epidural hematoma evacuation performed after three days can also have successful results

Bilateral abducens nerve palsy following ruptured anterior communicating artery aneurysm: report of 2 cases

Rara vez se ha publicado un caso de parálisis aislada del nervio abductor craneal, asociada a un aneurisma. Su asociación con un aneurisma de la arteria comunicante anterior (ACoA) es todavía más rara. Los mecanismos propuestos son la formación de un coágulo intracisternal y la hipertensión intracraneal. Aportamos dos casos de parálisis bilateral del sexto par, después de la ruptura de aneurismas de la ACoA y discutimos los mecanismos posibles. La apertura de la membrana de Liliequist da lugar a una mejoría clínica, debido a la liberación de l.c.r

Isolated abducens nerve palsies associated with intracranial aneurysms have rarely been reported. Their association with anterior communicating artery (ACoA) is even rarer. Intracisternal clot formation and elevated intracranial pressure has been proposed to be the responsible mechanisms. Here with, we report two cases of bilateral abducens palsies following ruptured ACoA aneurysms and speculated the possible mechanisms. Opening of Liliequist's membrane provides clinical improvement due to CSF release

Ganglioglioma with lytic skull lesions: a case report

Los gangliocitomas representan sólo el 0'4% de lostumores del sistema nervioso y el 1'3% de los tumorescerebrales. Son tumores benignos con baja mortalidad ymorbilidad y los pacientes solían presentarse con crisiscomiciales. Nunca se ha presentado un ganglioglioma enel adulto acompañado de lesión lítica craneal.Presentamos el caso de una mujer de 49 años,diestra, que había presentado crisis generalizadascon hemiparesia izquierda. La RM y el estudiohistopatológico mostraron un ganglioglioma grado II enla clasificación de la OMS y las Rx de cráneo revelaronlesiones líticas, por lo que consideramos que este tumordebe entrar en la lista del diagnóstico diferencial de laslesiones líticas craneales

Gangliogliomas represent only 0.4% of central nervoussystem neoplasms and 1.3% of brain tumors. They arebenign neoplasms with low morbidity and mortalityand the patients usually present with seizures, but therehas been no adult ganglioglioma with lytic skull lesion.A 49-year-old right handed woman sufferingfrom generalized epileptic seizures was admittedto our hospital. She had also left hemiparesis with4/5 motor strength. Magnetic resonance imaging andimmunohistochemical studies revealed WHO GradeII ganglioglioma. Skull X-ray showed the lytic skulllesions.We have to consider gangliogliomas in the differentialdiagnosis of lytic skull lesions

Primary spinal cord oligodendroglioma. Case illustration / Oligodendroglioma primario de la médula espinal. Caso clínico

Spinal cord oligodendrogliomas are rare pathologies of the spinal cord, and their location at conus and/or filum terminale is even rarer. There are only 7 spinal cord oligodendrogliomas reported in the literature. Our case is the eighth spinal cord oligodendrogliomas at this location (AU)

Los oligodendrogliomas de la médula espinal son raros y su localización en el cono medular o del filum terminale son aún menos frecuentes. Sólo hay siete oligodendrogliomas de la médula encontrados en la literatura. Nuestro caso es el octavo oligodendroglioma medular con esta localización (AU)