Extrusion of peritoneal catheter through a thoracic skin fistula: report of a rare complication of ventriculoperitoneal shunt.

A very rare complication of ventriculoperitoneal shunt is presented. The tip of the distal catheter extruded through a skin fistula in the right subclavian region. After the replacement of a new catheter in the peritoneal cavity, inflammation of the overlying scar occurred. Then, a ventriculoatrial shunt was carried out. The authors suggest a possible mechanism of this complication.

Post-traumatic subarachnoid pneumocephalus. A case report.

We present a case of subarachnoid pneumocephalus fed through a basal bony breach and confined to the cysterns of the Willis circle in a traumatized patient. The peculiar configuration of the pneumocephalus is attributed to the partial obliteration of the subarachnoid space due to the increased intracranial pressure.

The value of some clinical and computer tomographic parameters in the prognosis of surgically treated patients with intracerebral hematoma.

The six-month follow-up of 83 surgically treated cases for intracerebral hematoma (ICH) was examined in relation to some clinical and computer-tomographic parameters (age, sex, accompanying diseases, clinical features, localization, ventricular involvement, time elapsed between stroke and surgery). Clinical and laboratory pre-requisites for admittance to the study were: 1) ICH with subcortical major component greater than 3 cm. in diameter, 2) a Glasgow Coma Scale (GCS) score at/or superior than 5, 3) any evidence of trauma, aneurysm, A-V malformation and tumor and 4) surgery not later than 96 hrs. after onset of bleeding. The role of the clinical picture and the ventricular involvement of ICH was strinkingly significant on both mortality as well as recovery rates while sex, some accompanying diseases and left localization influenced the recovery rate. Time elapsed between bleeding and surgery was not considered an objective parameter due to the variability of some organizatory and human factors. Age was an uninfluential factor.

Intracerebral hematoma following removal of chronic subdural hematoma. Report of two cases.

Two cases of intracerebral hemorrhage consequent to surgery planned for homolateral chronic subdural hematoma are reported. Both patients were treated conservatively and made a satisfactory recovery. The pathological events leading to the formation of an intracerebral hematoma following the evacuation of a chronic subdural hematoma still remain undefined.

Photodynamic therapy of malignant brain tumors: clinical results of, difficulties with, questions about, and future prospects for the neurosurgical applications.

Photodynamic therapy (PDT) has been applied in a variety of oncological fields with good results. In neurosurgery, the clinical series are limited and the number of treated patients is not statistically significant. This work examines the results of PDT performed in our clinic and discusses some difficulties and causes of failure of this method in neurosurgical patients. Eight patients with malignant brain tumors underwent PDT. All had been treated previously by operation and radiation therapy and one patient had also received chemotherapy. At 24 hours after the i.v. injection of hematoporphyrin (5 mg/kg body weight), the tumor was removed as radically as possible and the residual tumor bed was exposed to either 630-nm light from an argon-dye laser or 600- to 680-nm light isolated from the emission of a quartz-halogen lamp. The type of sensitizer, the irradiation methods, and the peculiarities of glial tumors are examined as possible causes of failure. The longer survivals of some patients with glial tumors treated by PDT may make this treatment suitable when traditional therapies fail.

Subchoroidal approach to the third ventricle. Microsurgical anatomy.

The third ventricle can be approached by performing a few surgical maneuvers: (a) dividing the ependyma on the inferolateral aspect of the choroid plexus of the lateral ventricle; (b) separating leptomeningeal bundles within the tela chorioidea, and (c) dividing the roof of the third ventricle along the stria medullaris. Main landmarks are the thalamostriate vein and the direct lateral vein. Small subependymal veins or neural branches of the posterior medical choroidal artery, or both, occasionally cross the access route. The third ventricle is seen through both the opening in the roof and the foramen of Monro. A wider exposure can be obtained by cutting the terminal segment of the thalamostriate vein.

Mobile neurinoma of the cauda equina. Case report.

A mobile neurinoma arising from a redundant nerve root of the cauda equina is reported. The abnormal length of the nerve root allowed the neoplasm to move in the cranio-caudal direction along two segments of the spine.

Aminoacid incorporation into polyribosomes of ischaemic and reperfused gerbil brain.

Aminoacid incorporation into polyribosomes from the gerbil brain in a cellfree system is strongly affected by experimental ischaemia. Progression of the impairment of the protein synthesis in vitro occurs even following early reperfusion.

[Microsurgical extirpation of extra-pial angiomas of the pons]. / Mikdrochirurgische Exstirpation extrapial gelegener Angiome des Pons.

Some arteriovenous malformations that are apparently located in the pons are in reality located on its surface. Thus, their extrapial dissection is possible. This is carried out under the surgical microscope and by means of the microtechnique. To nine available descriptions, the results obtained in four of our own patients are added: Three angiomas were in an extrapial antero-lateral position, one angioma reaching into the cerebellar hemisphere and causing a cerebellar haematoma. The fourth angioma was in the Brachium pontis and reached to the Flocculus and Loculus quadrangularis inferior. The patients (2 females, 2 males) were subjected to a subtemporal-transtentorial operation, the brachium-pontis angioma was operated on occipitally. Complete restoration was reached after the operation and the former activites were taken up again. The diagnosis was based on series angiography and computer tomography. The afferent vessels stemmed from one or several cerebellar vessels. The removal of the angioma requires the most subtile preparation.

Effect of reperfusion on the uptake of [3H] uridine in the gerbil brain after prolonged ischaemia.

The uptake of labelled uridine is reduced in the whole ischaemic hemispheres of gerbils subjected to unilateral carotid artery occlusion. Following circulatory restoration, brain structures that had an ischaemic insult of moderate intensity exhibit a progressively increased uptake. However, during reperfusion there is a tendency towards a clear cut definition of dead zones. This progression of the lesions seems to be related to a maturation phenomenon occurring in areas with an irreversible damage at the end of the ischaemic period.