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1.
Surg Neurol ; 53(5): 488-92; discussion 492, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10874149

RESUMO

BACKGROUND: An extremely rare case of intracranial aneurysm associated with catecholamine-secreting carotid body tumor is presented. CASE DESCRIPTION: A 64-year-old woman suffering from hypertensive attacks was admitted first to the Otolaryngology Department with a neck swelling. Right common carotid angiography revealed a hypervascular mass at the carotid bifurcation. On the same angiogram a middle cerebral artery aneurysm was discovered incidentally and the patient was referred to the Neurosurgical Department. Because of her history the tumor was considered to be endocrinologically active and the patient underwent alpha- and beta-blockade to protect intraoperative cardiovascular instability. Despite all precautions, during the operation hypertensive crises developed and the aneurysm was clipped with difficulty. CONCLUSION: Perioperative management designed to avoid complications in treating this rare association is discussed. Although this is the first reported case of an intracranial aneurysm associated with a functional carotid body tumor, a possible etiopathogenesis of the relationship between the aneurysm and hypertensive attacks due to an acute catecholamine-discharging tumor is presented.


Assuntos
Tumor do Corpo Carotídeo/complicações , Tumor do Corpo Carotídeo/diagnóstico , Catecolaminas/metabolismo , Hipertensão/etiologia , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Idoso , Tumor do Corpo Carotídeo/diagnóstico por imagem , Tumor do Corpo Carotídeo/metabolismo , Angiografia Cerebral , Diagnóstico Diferencial , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem
2.
Surg Neurol ; 52(5): 485-9, 1999 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-10595769

RESUMO

OBJECTIVE: A case of postoperative tension pneumocephalus after low basilar trunk aneurysm clipping is presented. To our knowledge, this is the first case of isolated prepontine tension pneumocephalus. BACKGROUND: A 63-year-old woman was admitted for repair of a basilar aneurysm that had caused a subarachnoid hemorrhage. She was cooperative and partially oriented. According to Hunt & Hess classification, she was considered Grade III. METHOD: The aneurysm was clipped, using a right lateral suboccipital craniectomy with the patient in the sitting position. In the early postoperative period, she had no new neurological deficit. However, 2 hours later the patient became lethargic and unresponsive to verbal commands. Emergency CT scan revealed an isolated prepontine tension pneumocephalus with prominent posterior displacement of the pons. She was immediately taken back to surgery. Upon incision of the dura mater, air could be heard escaping under pressure from the posterior fossa cavity. The clip was in its proper position and all arteries were patent. Spontaneous respiration and pupil reflexes returned soon after surgery, but she remained unconscious and died 3 days later. CONCLUSION: We believe that this death was directly attributable to the tension pneumocephalus and the distortion of the pons. Postoperative prepontine tension pneumocephalus, although this is an extremely rare condition, should be considered if a patient deteriorates after basilar aneurysm surgery in the sitting position.


Assuntos
Artéria Basilar/cirurgia , Aneurisma Intracraniano/cirurgia , Pneumocefalia/etiologia , Complicações Pós-Operatórias , Artéria Basilar/diagnóstico por imagem , Angiografia Cerebral , Evolução Fatal , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Pessoa de Meia-Idade , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/fisiopatologia , Pneumocefalia/cirurgia , Ponte/diagnóstico por imagem , Ponte/fisiopatologia , Reoperação , Tomografia Computadorizada por Raios X
3.
Childs Nerv Syst ; 15(8): 395-402; discussion 403, 1999 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10447611

RESUMO

Six patients admitted to the Department of Pediatric Neurology at Hacettepe University Children's Hospital between 1992 and 1997 with a clinical diagnosis of Rasmussen encephalitis received surgical treatment for their intractable epilepsy. MRI, SPECT and WADA tests were performed in patients with an epileptic focus demonstrated on routine or long-term video EEG monitoring. Viral studies using the PCR methodology were performed in cases with histopathological evidence of Rasmussen encephalitis. The ages of these patients ranged between 7 and 16 years, and the mean age at onset of seizures was 7.1+/-2.2 years. In four patients seizures presented as epilepsia partialis continua and were refractory to anticonvulsive drug therapy. In three cases intravenous immunoglobulin therapy yielded temporary and partial improvement in seizure control. The mean presurgical follow-up duration was 2.04+1.74 years, and early surgical intervention for epilepsy was performed in one case. The surgical approach selected for the treatment of epilepsy was resective surgery with electrocorticography. The mean postoperative follow-up duration was 32.3+17.2 months. Seizures were fully controlled in one patient, in whom surgery was performed 3 months after the seizures first started. Early surgical intervention may provide histopathological evidence for diagnosis as well as effective seizure control.


Assuntos
Encefalite/complicações , Epilepsia/complicações , Criança , Pré-Escolar , Doença Crônica , Eletroencefalografia , Encefalite/diagnóstico , Encefalite/patologia , Encefalite/cirurgia , Epilepsia/diagnóstico , Epilepsia/cirurgia , Epilepsia/terapia , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imageamento por Ressonância Magnética , Masculino
4.
Turk J Pediatr ; 41(2): 161-72, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10770654

RESUMO

This study was conducted to evaluate the signs and symptoms on admission, diagnosis, localization, therapy, and survival of patients with primary intracranial germ cell tumors (PICGCT). Eight patients with surgically confirmed PICGCTs were treated and followed up at Hacettepe University's Department of Pediatric Oncology between 1974 and 1995. While one patient was admitted with a second recurrence of her disease, the others were admitted or referred primarily to our institution. In this period, 357 germ cell tumor and 684 primary intracranial malignant tumors were diagnosed and treated at our institution. Thus, PICGCTs comprised 1.1 percent of the primary intracranial malignant tumors and 2.2 percent of the germ cell tumors. There were four females and four males and the median age was eight years (13 months to 12 years). On admission, the most common symptoms were diabetes insipidus (3/8) and vomiting (3/8). One patient also and Down's syndrome. Locations of the tumors were suprasellar in three, in the third ventricle in two, and in the cerebral parenchyma, and pineal and hypothalamic regions in the remainder. There were germinomas, three malignant teratomas, and two mixed germ cell tumors. Only two patients could be treated with appropriate and adequate chemotherapy and radiotherapy. Three patients died: one in the postsurgical period, one after the third surgical approach and one 11 months after the diagnosis of progressive disease; three were lost to follow-up. The remaining two patients (with second recurrence and disseminated disease) are alive and without disease. Our experience with these patients demonstrated that appropriate and adequate chemotherapy is as effective a treatment as radiotherapy, even with recurrence of the disease.


Assuntos
Neoplasias Encefálicas/terapia , Germinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Encéfalo/patologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Criança , Pré-Escolar , Terapia Combinada , Diabetes Insípido Neurogênico/etiologia , Evolução Fatal , Feminino , Germinoma/complicações , Germinoma/diagnóstico , Humanos , Lactente , Masculino , Recidiva Local de Neoplasia , Radioterapia
5.
Acta Neurochir (Wien) ; 140(7): 655-8, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-9781278

RESUMO

This paper presents two unique cases of subdural tension pneumocephalus which has deteriorated in the early phase of head trauma. Subdural pneumocephalus accounts for about 25% of all intracranial pneumocephalus cases. In the literature subdural pneumocephalus is describes as a benign and spontaneously resolving condition. Contrary to the available literature and our experience in 1341 trauma cases in the past ten years of whom 76 had subdural pneumocephalus, both cases deteriorated in the early hours following head trauma due to an increase in subdural air volume which was evacuated by craniotomy.


Assuntos
Traumatismos Cranianos Fechados/complicações , Hipertensão Intracraniana/cirurgia , Pneumocefalia/cirurgia , Adolescente , Adulto , Craniotomia , Traumatismos Cranianos Fechados/diagnóstico por imagem , Traumatismos Cranianos Fechados/cirurgia , Humanos , Hipertensão Intracraniana/diagnóstico por imagem , Masculino , Pneumocefalia/diagnóstico por imagem , Espaço Subdural , Tomografia Computadorizada por Raios X
6.
Neuroradiology ; 39(5): 367-70, 1997 May.
Artigo em Inglês | MEDLINE | ID: mdl-9189885

RESUMO

We present a 4-year-old child who suffered bilateral third nerve palsies secondary to bilateral giant saccular cavernous carotid artery aneurysms. Endovascular treatment was performed by means of direct endosaccular aneurysm occlusion on the right side and parent vessel occlusion on the left, using mechanically detachable coils. No complication occurred during or after the procedure. The bilateral third nerve palsies resolved over 3 months. Follow-up angiography at 1 year is presented.


Assuntos
Aneurisma/terapia , Doenças das Artérias Carótidas/terapia , Embolização Terapêutica , Aneurisma/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Pré-Escolar , Embolização Terapêutica/instrumentação , Feminino , Humanos , Radiografia
7.
Br J Neurosurg ; 11(6): 501-7, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11013621

RESUMO

Meningiomas are relatively uncommon in childhood. They represent 1 to 2% of all intracranial tumours of infancy and childhood. During the last 30-year period, from 1964 to 1993, 13 children with a diagnosis of meningioma were operated on at the Department of Neurosurgery, Hacettepe University School of Medicine. The meningiomas in the paediatric age group were characterized by multiplicity (23%), frequent association with neurofibromatosis (23%), intraventricular location (8%), and the presence of a cystic component in the tumour tissue (23%). These findings in children differ from those in adults. This study constitutes a retrospective analysis of these cases and a review of the literature.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Microcirurgia , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
8.
Angiology ; 47(6): 627-32, 1996 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8678339

RESUMO

Fibromuscular dysplasia (FMD) of intracranial arteries is seen rarely and usually limited to the intrapetrosal internal carotid artery or carotid siphon. The authors report a case with recurrent subarachnoid hemorrhage diagnosed angiographically as FMD with extensive involvement of intracranial arteries. Angiography showed large fusiform dilatations and multiple aneurysms along the left intracranial internal carotid artery into its major branches, middle cerebral and posterior communicating arteries, and tip of the basilar and posterior cerebral arteries. Such an angiographic appearance has not been previously reported. Radiologic findings are demonstrated and possible pathophysiologic mechanisms are discussed.


Assuntos
Transtornos Cerebrovasculares/diagnóstico , Displasia Fibromuscular/diagnóstico , Adulto , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/epidemiologia , Angiografia Cerebral , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Displasia Fibromuscular/complicações , Displasia Fibromuscular/epidemiologia , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/etiologia , Angiografia por Ressonância Magnética , Masculino , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Tomografia Computadorizada por Raios X
9.
Aust N Z J Surg ; 66(3): 144-50, 1996 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-8639130

RESUMO

BACKGROUND: Meningiomas usually grow slowly but they may cause recurrences despite surgical resection. The impact of clinical, neuroradiological and surgical characteristics on operative morbidity and mortality of patients operated on for intracranial meningioma was analysed. METHODS: A series of 450 patients operated on for intracranial meningiomas at the Department of Neurosurgery, Hacettepe University Hospital during the period 1964-1992 is reported. The surgical results were analysed with regard to intracranial site, extent of removal, histological type, and different time periods. Computed tomography (CT) and magnetic resonance imaging (MRI) facilitated the diagnosis and helped with the planning of treatment. RESULTS: Two hundred and ninety-two patients were examined with both CT and MRI. Overall mortality was 4% but showed a decline from 9% in the pre-CT era to 3% in the post-CT era and to 1% in the past 3 years. CONCLUSIONS: Operative mortality and recurrence rates are affected by the intracranial location of the tumour, histological type, and extent of tumour removal. Emphasis is also given to the importance of the introduction of the imaging techniques, and the microsurgical techniques with the Cavitron ultrasonic surgical aspirator (CUSA), laser, and/or bipolar coagulator which have further improved the operative mortality and recurrence rates.


Assuntos
Neoplasias Encefálicas/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Criança , Pré-Escolar , Eletrocoagulação , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Terapia a Laser , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/mortalidade , Neoplasias Meníngeas/patologia , Meningioma/mortalidade , Meningioma/patologia , Microcirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Planejamento de Assistência ao Paciente , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Turquia/epidemiologia , Terapia por Ultrassom
10.
J Craniomaxillofac Surg ; 24(1): 40-5, 1996 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8707941

RESUMO

A series of 49 patients with trigeminal neuralgia (TN) were treated by three different surgical procedures: (1) peripheral ablative procedures in 10 patients; (2) percutaneous rhizotomy in 17 patients and (3) intracranial rhizotomy (IR) in 22 patients. On the basis of surgical treatment, the concept that neurovascular compression is a mechanical factor in the aetiology of TN was supported in 14 to 18 patients who underwent posterior fossa exploration. The results support the conclusion that retromastoid craniectomy with IR is the procedure of choice for the majority of patients with TN.


Assuntos
Rizotomia , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Angiografia , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/etiologia
11.
J Vasc Interv Radiol ; 7(1): 75-9, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8773978

RESUMO

PURPOSE: To determine the usefulness of mechanically detachable spiral tungsten coils (MDSs) in the endovascular, endosaccular occlusion of intracranial aneurysms. MATERIALS AND METHODS: Anterior communicating artery aneurysms shown at angiography in two patients and a basilar tip aneurysm shown in one patient were treated with MDSs. RESULTS: In the basilar artery aneurysm, eight coils were delivered. Two additional coils were placed at 3 months because of filling of the residual aneurysm neck. Angiography at 1 year showed no recanalization. The smaller aneurysm in the anterior communicating artery was totally occluded by a single coil. Angiography at 6 months showed no recanalization. The other aneurysm was occluded by two coils, with a small amount of residual filling. A third coil was withdrawn before detachment. The patient had aspiration pneumonia and electrolyte imbalance, but he was in stable condition 3 weeks later and was discharged. CONCLUSION: The pliable, soft, retrievable MDS system provides instantaneous release of a spiral coil.


Assuntos
Artéria Basilar , Embolização Terapêutica , Aneurisma Intracraniano/terapia , Tungstênio , Adulto , Angiografia Cerebral , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Seguimentos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
12.
Childs Nerv Syst ; 11(9): 533-5, 1995 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8529220

RESUMO

Horner's syndrome may be caused by a lesion anywhere along the three-neuron pathway from the hypothalamus to the eye. This syndrome has been reported secondary to numerous causes to date. In this paper, we describe an extremely rare case of Horner's syndrome due to jugular venous extasia demonstrated by computed tomography and intravenous digital subtraction angiography.


Assuntos
Síndrome de Horner/diagnóstico , Síndrome de Horner/etiologia , Veias Jugulares/fisiopatologia , Angiografia Cerebral , Criança , Humanos , Masculino , Tomografia Computadorizada por Raios X
13.
J Craniomaxillofac Surg ; 23(1): 1-5, 1995 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-7699076

RESUMO

Congenital encephaloceles are rare lesions which are usually seen in the occipital region, in the West. They may rarely be seen in the frontal region and they have distinct diagnostic features, together with several other pathological conditions occurring in this region. In order to emphasize these points, a retrospective analysis of 35 cases which have been operated on in our clinic, is made in this study. The findings are compared with the data obtained from the literature.


Assuntos
Encefalocele/cirurgia , Osso Nasal/anormalidades , Transplante Ósseo , Criança , Pré-Escolar , Craniotomia , Encefalocele/epidemiologia , Feminino , Osso Frontal/anormalidades , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Turquia/epidemiologia
15.
Int Orthop ; 18(5): 284-7, 1994 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7852007

RESUMO

Secondary extradural spinal tumours are very rare, but they comprise most of the extradural neoplasms seen in infancy and childhood. Thirty-nine patients with this type of secondary tumour were treated in our hospital between 1965 and 1991. The diagnosis was proved by biopsy in every case. Following surgical decompression, all 35 survivors had radiotherapy and/or chemotherapy. Their outcome is reported.


Assuntos
Neoplasias da Coluna Vertebral/secundário , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Diagnóstico por Imagem , Feminino , Humanos , Lactente , Masculino , Avaliação de Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia
17.
Pediatr Neurol ; 10(1): 75-7, 1994 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8198678

RESUMO

A patient with dermoid tumor, presenting with persistent hypoglycorrhachia in the absence of cerebrospinal fluid pleocytosis is reported. The presence of ring enhancements without infection, surrounding edema, and mass effect on computed tomography and magnetic resonance imaging are unusual findings for these tumors.


Assuntos
Glicemia/metabolismo , Neoplasias Cerebelares/diagnóstico , Neoplasias do Ventrículo Cerebral/diagnóstico , Cisto Dermoide/diagnóstico , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/cirurgia , Cerebelo/patologia , Cerebelo/cirurgia , Neoplasias do Ventrículo Cerebral/patologia , Neoplasias do Ventrículo Cerebral/cirurgia , Ventrículos Cerebrais/patologia , Ventrículos Cerebrais/cirurgia , Cisto Dermoide/patologia , Cisto Dermoide/cirurgia , Humanos , Lactente , Masculino
18.
Acta Neurochir (Wien) ; 127(3-4): 166-9, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-7942198

RESUMO

Thirteen patients admitted to hospital mainly with visual disturbances (100%), retarded growth (39%) and diabetes insipidus (23%) were all diagnosed as ossified adamantinous craniopharyngioma. Tumour size was found to be large in all patients. Localization displayed a heterogenous dissemination; 8% intra-suprasellar, 69% suprasellar-extraventricular, 15% extra-intraventricular, and 8% in the suprasellar region extending bilaterally to the frontal and temporal lobes. During the early postoperative period, four patients died with hypothalamic deterioration. Three patients underwent a second operation in view of recurrence, and one died from an infection. Thus, the postoperative survival rate was 62%. All the patients who survived continued to have visual disturbances, but only one deteriorated. Five patients exhibited diabetes insipidus during the postoperative period, among them 4 after surgical intervention and 5 patients displayed panhypothyroidism, three of them after surgery. Consequently, it is confirmed by the present review that craniopharyngiomas still offer a potential dilemma in their management. Difficulties caused by adhesion or invasion of ossified craniopharyngiomas and thus the increase in morbidity and mortality during surgical intervention and in the postoperative period are discussed.


Assuntos
Craniofaringioma/cirurgia , Ossificação Heterotópica/cirurgia , Neoplasias Hipofisárias/cirurgia , Adolescente , Adulto , Calcinose/diagnóstico , Calcinose/patologia , Calcinose/cirurgia , Criança , Craniofaringioma/diagnóstico , Craniofaringioma/patologia , Feminino , Humanos , Hipofisectomia , Masculino , Exame Neurológico , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/patologia , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/patologia , Tomografia Computadorizada por Raios X
19.
Paraplegia ; 31(6): 412-4, 1993 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8337007

RESUMO

Giant-cell tumours of the spine are very rare. They occur mainly in long bones. We report a patient with a giant-cell tumour of the lumbar spine which had been operated on at another hospital 5 months previously as a protruded lumbar intervertebral disc.


Assuntos
Tumores de Células Gigantes/patologia , Neoplasias da Coluna Vertebral/patologia , Feminino , Tumores de Células Gigantes/cirurgia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/cirurgia
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