Chiari malformation type III and results of surgery: a clinical study: report of eight surgically treated cases and review of the literature.

BACKGROUND: The characteristics of Chiari malformation type III and its treatment are evaluated in this study. Radiological and surgical findings were correlated and the benefits of the therapy are discussed. METHODS: Eight patients (6 males, 2 females) with Chiari malformation type III were studied. All patients underwent surgery to remove encephalocele along with neural tissue and to repair the dura and the skin. Associated pathologies such as hydrocephalus, tethered cord syndrome and syringomyelia were also surgically treated. Follow-up was based on the evaluation of postoperative motor and mental development, as well as on magnetic resonance imaging findings. RESULTS: Ventriculoperitoneal shunt malfunction in 2 patients was the only surgical complication. One patient died 10 days after the operation, 7 patients survived, and the outcome of 2 patients was quite poor because of severe mental retardation and neurological deficits at the beginning. In the remaining patients, motor and mental development was normal, and the neurological outcome was satisfactory. CONCLUSION: Surgery in the newborn period, initial severity of neurological deficits, the presence of intermittent apnoea, delayed treatment of hydrocephalus and the amount of neuronal tissue within the excised encephalocele were determined as unfavourable prognostic factors for the outcome. If the appropriate surgical procedure is done at the right time, the outcome of the Chiari malformation type III patient can be satisfactory with a low mortality rate.

Cerebral alveolar echinococcosis. A case report with MRI and review of the literature.

Alveolar echinococcosis is an important zoonotic infection caused by the larval stage of the Echinococcus multilocularis. It is endemic to North America, Central Europa, Russia, China and Turkey. The liver and the lung are the organs most commonly involved. Cerebral alveolar echinococcosis is rare accounting for only 1% of cases. We present a 55-year-old patient with a right frontal mass. T2-weighted MRI series revealed a grape like multilobular, heterogeneous mass with low density. A diagnosis of glial tumor was made. The mass was totally removed. The histopathological examination showed a diffuse growth composed of compartments that are filled with a gelatinous matrix and many brood capsules and protoscolices filled with necrotic tissue. Histopathological findings were consistent with the diagnosis of alveolar echinococcosis. No postoperative complications were observed. There were no lesions in the liver and lungs. The patient was started on albendazole (ABZ) at a daily dosage of 800 mg for 3 months. The patient has remained free of any mass lesion for 5 years. Hypointense grape-like mass with calcification and surrounding white matter edema in T2-weighted MRI should suggest cerebral alveolar echinococcosis. Radical surgery and an adjuvant therapy with ABZ provides useful prolongation of life.

Spinal meningiomas: evaluation of 41 patients.

AIM: Spinal meningiomas are relatively frequent intraspinal tumors. They constitute 25-46% of all primary spinal neoplasms. METHODS: Forty-one patients with spinal meningiomas surgically treated between 1986 and 2001 are reviewed in this report. There were 32 females and 9 males, aged 16 to 73 years old. Tumor location was cervical in 7 cases and thoracic in 34 cases. All tumors were intradural. All of the patients were operated by laminectomy in prone position. RESULTS: Total excision was achieved in 40 (98%) patients and subtotal excision in 1(2%). The majority of the tumors were meningothelial (42%) or psammomatous (25%). There was no surgical mortality. Four patients (10%) suffered from morbidity: One patient with CSF fistula, 1 deep venous thrombosis, 1 case with paraparesis and 1 wound infection was seen. Neither multiple meningiomas nor malign meningiomas were seen in our series. CONCLUSIONS: Spinal meningiomas are benign tumors and should be excised totally. If the preoperative neurological status is not complicated, fairly good outcome can be achieved.

Two unusual complications of ventriculo-peritoneal shunts. Report of two cases.

Two cases in which thoracal extrusion and cervical disconnection complicated ventriculo-peritoneal shunts are reported. Other complications of distal shunts are also reviewed.

Choroid plexus arteriovenous malformation (AVM) in a newborn. Case report.

We report here on an unusual case of AVM with intraventricular hemorrhage in a full-term newborn infant. Clinical and radiological findings are discussed in the light of the recent literature.

Treatment of acute spinal cord injuries: comparison of thyrotropin-releasing hormone and nimodipine.

The effects of nimodipine and thyrotropin-releasing hormone (TRH) were compared in a clip-compression model of experimental spinal cord injuries (SCI) in rats. Thirty rats received a 50-g clip-compression injury on the cord at T9. Ten rats were given 0.02 mg/kg nimodipine and dextran 40 (3 ml) i.v. 1 h after injury. Ten rats were given 2 mg/kg TRH and dextran 40 (3 ml) i.v. 1 h after injury followed by 1 mg/kg per hour for 4 h. The remaining ten rats were given only saline. TRH treatment significantly improved somatosensory-evoked potentials (SEPs) and mean arterial blood pressures (MABPs), whereas nimodipine treatment had no effect on these variables (Fisher's exact test (P less than 0.01).

Intraventricular meningioma of the fourth ventricle.

A rare case of meningioma of the fourth ventricle is reported. A review of the literature revealed only 24 reported cases of this type of tumor.

Brain abscess caused by Brucella abortus and Staphylococcus aureus in a child.

A case of a 12-year-old male with Fallot's tetralogy and brain abscess due to Brucella and Staphylococcus is presented. The abscess was aspirated and Brucella abortus and Staphylococcus aureus were isolated.

Medical treatment of acute spinal cord injuries.

The injury was performed with 600 g-cm/weight on the spinal cord of 40 cats with T8-9 laminectomy in this study. Ten cats were given 10 mg/kg naloxone i.v. 1 h after injury. Ten cats were given 2 mg/kg thyrotropin-releasing hormone (TRH) i.v. 1 h after injury followed by 1 mg/kg per hour for 4 h. Intravenous lidocaine was begun 30 min after injury in ten cats, administered as 1.5 mg/kg over the initial 5 min, 3 mg/kg over the next 30 min and 1 mg/kg every 30 min for 4 h. The remaining ten cats were given only saline (control group). TRH-treated cats showed significantly better histopathological scores than either naloxone- or lidocaine-treated animals (KW:13.65, P less than 0.50).

Intracerebral myiasis from Hypoderma bovis larva in a child. Case report.

Cerebral myiasis with a 10-day history of convulsions due to an intracerebral hematoma caused by a Hypoderma bovis larva is reported in an 8-year-old child. Computerized tomography (CT) showed the hematoma in a right parieto-occipital location. The H. bovis larva and the extensive intracerebral hematoma were discovered during surgery. Among human parasitoses, cerebral myiasis is rare: a review of the literature revealed only two reports, one published in 1969 and one in 1980. This is the first case that has been diagnosed as cerebral myiasis with exact identification of the Hypoderma bovis larva both from the CT scans and at surgery in a patient during life.