Therapeutic management of intraventricular cavernoma: case series and review of the literature.

Intraventricular cavernoma (IVC) is a rare intracranial vascular malformation and only 100 cases of IVC have been described in the literature. Although IVCs share some common characteristics with intraparenchymal cavernomas, they also have some distinct features involving structure, clinical symptoms, radiologic appearance, and onset of symptoms. This review presents our experience, consisting of five IVC cases over a period of 11 years. We describe the symptoms leading to hospital admission, the main radiologic findings, the management of each ICV case, and the patients' clinical status after surgery. We also reviewed the international literature on IVC, presenting the main demographic characteristics, their most common location in the ventricular system, and the main signs and symptoms. Finally, we present the management options according to the current literature, the advantages and disadvantages of every management option, accompanied by a brief follow-up of most IVC cases, whether the cavernoma was treated surgically or conservatively.

Radiculopathy after lumbar discectomy due to intraspinal retained Surgicel: clinical and magnetic resonance imaging evaluation.

BACKGROUND CONTEXT: Lumbar radiculopathy after lumbar spine surgery is an alerting sign usually caused by either a recurrent disc herniation or epidural hematoma. However, pressure on a spinal nerve root may also be exerted by a retained piece of Surgicel used to achieve hemostasis during lumbar spine surgical procedures. PURPOSE: To describe a case of lumbar radiculopathy that was caused by a piece of Surgicel left in the spinal canal after operation for lumbar disc herniation. STUDY SETTING: A case report of a retained piece of Surgicel being the cause of S1 radiculopathy. METHODS: Patient interview, medical records, imaging studies, and literature review. RESULTS: A 29-year-old man developed acute left S1 radiculopathy after a successful hemilaminectomy and discectomy operation for a L5-S1 disc herniation. In the magnetic resonance imaging studies that were performed, a postoperative hematoma could not be excluded and a reoperation revealed compression from Surgicel that was used for hemostasis. The patient was free of symptoms after reoperation. CONCLUSIONS: This case depicts the difficulty in distinguishing-by means of magnetic resonance imaging-nerve root compression caused by a postoperative hematoma and a recurrent disc herniation, from that caused by a retained Surgicel. Therefore, hemostatic agents should be meticulously used in spine surgery.

Giant osteoma of the frontoethmoidal sinus associated with two cerebral abscesses.

A 36-year-old woman presented with severe frontal headache, fever, left palpebral swelling, and proptosis. Radiographic studies showed a giant frontoethmoidal osteoma, that extended intracranially into the frontal lobe and was associated with two abscesses, one within the lesion and the other in the right frontal lobe. The tumour was excised and the abscesses drained. The patient made a full recovery.

Early cerebral monitoring using the transcranial Doppler pulsatility index in patients with severe brain trauma.

BACKGROUND: The early posttraumatic period is critical in patients with traumatic brain injury (TBI) because of the increased risk of secondary ischemic injuries to the injured brain. For these patients, cerebral perfusion pressure (CPP) monitoring is recommended. This, however, requires an invasive device to measure intracranial pressure (ICP). Transcranial Doppler (TCD) ultrasonography is an effective, noninvasive method for the detection of cerebral hemodynamic changes. Use of the dimensionless TCD-pulsatility index (PI) has the advantage of eliminating errors in measurements due to insonation angle variations. MATERIAL/METHODS: We investigated 37 patients with severe TBI (GCS < or = 8 on admission). The TCD parameters included the systolic, diastolic, and mean velocities of the middle cerebral artery (MCV) and the pulsatility index (PI). Mean arterial pressure (MAP), ICP, CPP, and simultaneous arterial and venous blood gases were also measured. RESULTS: We observed a strong correlation between ICP and PI (r = 0.82, p < 0.0001) for ICP values >20 mmHG. The correlation of CPP to PI were also statistically significant (P < 0.0001). The strongest inverse correlation between CPP and PI was obtained (r = 0.86, p < 0.0001) for CPP values below 70 mmHg. CONCLUSIONS: Pulsatility index measurements permit the early identification of patients with low CPP and high risk of cerebral ischemia. In emergency situations it can be used alone when ICP monitoring is contraindicated or not readily available.

Surgical management of cerebral metastases from non-small cell lung cancer.

AIMS AND BACKGROUND: The objective of the study was to assess the efficacy of surgical resection of solitary brain metastasis in patients with non-small-cell lung cancer. METHODS AND STUDY DESIGN: We report a retrospective analysis of 32 patients with single brain metastasis surgically excised at our hospital. All but one patient underwent postoperative whole brain radiation therapy. RESULTS: The median survival of patients was 12.5 months postoperatively (mean, 17 months), and the overall 1-year survival was 53%. Thirteen patients had recurrence of brain metastasis: 6 of 13 underwent reoperation for the recurrent lesion, and 1 of the 6 patients had a third craniotomy. Baseline characteristics, which significantly influenced survival, included age less than 60 years, tumor histology (ie, adenocarcinoma), and treatment of the primary lung cancer. The analysis did not yield any significant differences between treatment modalities. CONCLUSIONS: Our findings correspond well with those reported in the literature and suggest that surgical resection of single brain metastasis in patients with non-small cell lung cancer can improve survival over conservative management. Furthermore, surgical treatment of the primary tumor and the single brain metastasis, combined or not with radiotherapy and chemotherapy, represents an approach that merits further investigation with more patients and a prospective longitudinal design.

Intratumoral doxorubicin in patients with malignant brain gliomas.

The objective of the study was to evaluate the safety and therapeutic efficacy of intralesional administration of doxorubicin in brain gliomas. Ten patients with recurrent grade III or IV glioma were enrolled in the study, after the second operation. All patients had not responded to radiation therapy. Chemotherapy was administered directly in the tumor through an Ommaya pump placed in the site of disease at the time of craniotomy. Doxorubicin 0.5 mg was administered in the Ommaya reservoir every 24 hours on days 1 to 10. Patients were evaluated at 6- to 8-week intervals until tumor progression and death. All patients were evaluated for response. Six of 10 patients had clinical improvement lasting from 12 to 73 weeks. Objective radiologic response was observed in 5 of 10 (50%) patients. One patient achieved complete response with time to disease progression of 119 weeks, and 4 patients had a partial response (duration 14-39 weeks) with 25% or more reduction of tumor volume on computed tomography scan compared with pretreatment measurements. Time to disease progression in patients who responded after the intratumoral chemotherapy was 39.83 +/- 40.5 weeks. One additional patient had stable disease for a duration of 12 weeks. The median survival of the patients with response was 55.17 +/- 54.22 weeks (range: 21-164 weeks), whereas survival of those who did not respond was 17.0 +/- 12.36 weeks (range: 8-35) (Mann Whitney U test: z = -2.13, p = 0.033). The median survival of all 10 patients was 39.9 +/- 45.52 weeks (range: 8-73 weeks). Bifrontal headache was reported in 4 of 10 patients immediately after the administration of doxorubicin. There were no other clinically significant adverse reactions either in the brain or systematically. Intralesional administration of doxorubicin appears to be a safe and effective treatment and should be further explored in the management of brain gliomas resistant to conventional forms of treatment.