Primary malignant schwannoma involving simultaneously the right Gasserian ganglion and the distal part of the right mandibular nerve. Case report.

A 66-year-old man presented to our Department with trigeminal neuralgia of the third division of the right trigeminal nerve. He also complained of some difficulty in mastication because of a tumour mass in the right lower jaw. A brain CT scan, X-rays of the lower jaw and viscerocranium CT scan revealed a malignant schwannoma of the right Gasserian ganglion involving simultaneously the distal end of the right mandibular nerve. The patient was operated on and has undergone a course of external irradiation. Seven years later, he is living a normal life. The value of the preoperative diagnosis of this extremely rare pathology is discussed because it seems that this tumour is radiosensitive.

Results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy.

In this retrospective study 180 patients were submitted to anterior discectomy without fusion for cervical radiculopathy and myelopathy. Ninety-five patients presented with single-level discopathy, the main symptom being radiculopathy in this group. Eighty-five patients presented with multiple-level discopathy, the main symptom being myelopathy instead of radiculopathy. No serious complications were observed in either group. In the single-level discopathy group the improvement of the radiculopathy was 94.7% and of the myelopathy, 87.5%, whereas in the multiple-level discopathy group the improvement of the myelopathy was 57.1% and of the radiculopathy, 66.6%. It is concluded that anterior cervical discectomy without interbody fusion is a safe and effective surgical method for the treatment of radiculopathy and less so for myelopathy.

The symptomatic incompetent cervical intervertebral disc.

A series of 16 patients with symptoms such as pain in the neck, occiput, shoulder and arm; numbness in the hands; and/or difficulty in walking, is described. Neurological examination of the upper extremities disclosed signs of nerve roots dysfunction in 5 patients and long tract signs in 12, whereas examination of the lower extremities disclosed long tract signs in every patient. Positive contrast cervical myelograms suggested mild posterior bulging of one or two intervertebral discs in every patient, but computed tomographic myelograms invariably demonstrated a coincident narrow cervical spinal canal, thus revealing the true compressive potential of the aforementioned mild disc protrusion on the spinal cord. All patients underwent anterior cervical microdiscectomy of the offending disc or discs, which were found to be degenerated. No case of frank rupture of the anulus was identified. Response to treatment was graded as excellent in 12 patients, who had complete relief of symptoms, and good in 4 patients, who had mild residual complaints. This study suggests that incompetence (bulging) of a cervical intervertebral disc may acquire important clinical significance in the presence of a narrow spinal canal by compressing the spinal cord and the corresponding nerve roots. Surgical removal of the diseased disc may result in restoration of neurological function.

5-hydroxyindoleacetic acid (5-HIAA) levels in the cerebrospinal fluid of hydrocephalic children before and after ventricular shunting procedure.

21 cases of hypertensive hydrocephalus were investigated for lumbar 5-HIAA before and after operation. Seven groups (posterior fossa tumors) of patients aged between 2 and 12 years were tested after tumor removal; the others (nontumorous hydrocephalus) after ventricular shunting. This last group included 8 patients with noncommunicating hydrocephalus aged between 15 days and 12 years and 6 with communicating hydrocephalus aged between 6 months and 9 years. At the time of the second determination all patients presented an improvement of clinical signs of intracranial hypertension. A correlative analysis of 5-HIAA values before and after operation is made. In tumor cases, preoperative levels were higher than controls, and a significant decrease was found after operation in comparison with preoperative levels. In nontumor cases, a significant decrease was also observed in noncommunicating hydrocephalus, confirming clinical usefulness of the results for controlling the degree of the intracranial hypertension and, in consequence, shunt performance. In communicating cases the results were disappointing, because almost always postoperative levels did not differ from the preoperative ones. Possible interpretations of the data are analyzed.

Brain cortex phospholipids liposomes effects on CSF HVA, 5-HIAA and on prolactin and somatotropin secretion in man.

Liposomes obtained from bovine brain cortex phospholipids (BC-PL), which display several effects on brain function in mice, have been administered intravenously (200 mg) to healthy subjects at various times before diagnostic lumbar puncture. HVA and 5-HIAA concentrations in CSF have been evaluated with the aim of assessing changes of monoamines metabolism. An increase of HVA occurs after 2 hours from BC-PL administration, reaching its peak after 6--7 hours. The finding is interpreted as an index of an increased turnover of brain DA. 5-HIAA changes are less impressive and a smaller increase of the metabolite is observed. They cannot correctly be related to brain changes of serotonin metabolism, since 5-HIAA originates also from the spinal cord. No effects are observed on the secretion of prolactin, but somatotropin increases sharply between 2 and 7 hours from treatment, suggesting the possibility of an activation of the dopaminergic pathway, stimulating STH secretion.