Reconstruction of a large post-traumatic cranial defect with a customized titanium plaque.

The treatment of serious cranial defects has always been a fascinating and controversial issue for craniofacial surgeons and in the last years many solutions have been proposed. One of the most effective method is a personalized titanium plaque prepared by processing anatomical data obtained with a CAT of the patient. A case of wide cranial defect on the left fronto-parietal region in a 56-year-old man treated with a personalized titanium plaque obtained by processing the data of a spiral CAT of the skull is described. No complications were observed in the postoperative course and follow-up after 6 moths showed that the patient was in good general condition.

Cerebral blood flow changes induced by electrical stimulation of the Gasserian ganglion after experimentally induced subarachnoid haemorrhage in pigs.

The effect of trigeminal electrical stimulation on cerebral blood flow has been studied in conditions of normal or reduced cerebral blood flow (CBF). Autologous blood was injected into the subarachnoid space of ten Pittmann-Moore pigs to induce subarachnoid haemorrhage (SAH) accompanied by cerebral blood flow (CBF) reduction. One week later, in six of ten animals, a considerable decrease of CBF was noted as evaluated by means of a recording-system monitoring over the right parieto-temporal calvarium the washout of 133Xenon injected into the internal carotid artery after the external carotid had been clamped. Continuous electrical stimulation of the Gasserian ganglion performed in the six animals with severely induced CBF reduction produced a remarkable cerebrovascular dilation and increase of CBF lasting over 3 h. Electrical stimulation of the Gasserian ganglion produced a similar pattern of vasodilation in six pigs in which no blood was injected and no reduction of CBF was evident. The mechanisms and the anatomical pathways which underlie these results are discussed.

Evaluation of beta-endorphin/beta-lipotropin immunoreactivity content in the CSF of patients affected by deafferentation pain syndromes.

Beta-endorphin/beta-lipotropin immunoreactivity (BE/BLPH-IR) content was evaluated in the CSF of patients suffering by deafferentation pain syndromes. BE/BLPH-IR CSF concentrations of these patients were compared with those obtained in a group of patients affected by low back pain and in a control group without pain problems. No statistically significant variation in BE/BLPH-IR levels were found between controls and subjects with different types of chronic pain.

[Aneurysmal cysts of the fronto-parietal bone]. / Cisti aneurismatica dell'osso fronto-parietale.

The authors describe the case of a patient affected by an aneurysmal bone cyst of the fronto-parietal bone. A short review of the literature follows.

DST in chronic pain patients not suffering from major depression.

The relationship between chronic pain and depression is complex, and nonorganic chronic pain has been hypothesised (at least in some cases) as the expression of an underlying affective disturbance. Postdexamethasone cortisol nonsuppression was assessed in two groups of patients with chronic organic (n = 43) and nonorganic (n = 20) pain, none of them suffering from a major depressive disorder. Non-suppression occurred in 16.3% of the organic group and 20% of the nonorganic one. No difference emerged between the two groups for mean postdexamethasone cortisol values. The DST test results did not suggest the existence of a close relationship between chronic pain and major depressive disorder; however, a wider relationship between chronic pain and affective disturbances, at least in a subgroup of patients, cannot be ruled out.

Diencephalic syndrome following cervical spinal cord trauma.

The authors discuss about five cases of diabetes insipidus observed in patients affected by traumatic cervical spine fractures and/or dislocations, without either evident lesions of the cerebral structures at CT scan examination, or important craniocerebral trauma. In all patients polyuria and hyperthermia arose some days after the traumatic accident and regressed spontaneously or after exogeneous vasopressin administration. Vasopressin urinary levels confirmed the presence of a true diabetes insipidus, the origin of which is in largely obscure. A central medullary vasopressin mediated pathway, demonstrated only in experimental animals, may be responsible for such a finding.

Age-related changes of methionine-enkephalin and beta-endorphin/beta-lipotropin immunoreactivity in human CSF.

Methionine-enkephalin (ME-IR) and beta-endorphin (BE-IR) immunoreactive material CSF concentrations have been measured in subjects of different ages affected by lumbar or cervical disk hernia. The two peptides exhibited different age-related trends. ME-IR levels rose significantly with age while no changes were observed in the case of BE-IR.

The treatment of hemifacial spasm with percutaneous radiofrequency thermocoagulation of the facial nerve.

The authors present their first results with the treatment of hemifacial spasm by controlled percutaneous thermocoagulation of the facial nerve. Seven patients have been treated to date with good immediate results on the movements, although a slight paresis of the homolateral facial musculature, aesthetically acceptable, persists after treatment. A long-term follow-up at more than 10 months was achieved in only 3 patients, who showed a complete regression of the spasm with partial disappearance of the facial hemiparesis.

Percutaneous thermocoagulation for sphenopalatine ganglion neuralgia.

The authors describe percutaneous radiofrequency (rf) thermocoagulation of the sphenopalatine ganglion used to treat seven patients with sphenopalatine ganglion neuralgia. The procedure was effective in relieving pain, without significant side-effects. All the patients have actually been free of pain during a follow-up of 6-28 months. The surgical technique and the rationale for its use are pointed out.

Episodic secretion of met-enkephalin immunoreactive material in human plasma and CSF.

Plasma and CSF met-enkephalin immunoreactive material (ME-IR) concentrations were measured in 5 subjects at different hours of the day. Within the 24 hrs CSF ME-IR concentrations ranged in the same patient from 20 to 5000 pg/ml. Plasma ME-IR concentrations presented a circadian rhythm with lower values between 4:00 and 8:00 p.m.

Combined thermocoagulation of the 5th and 9th cranial nerves for oral pain of neoplastic aetiology.

The authors report their limited but interesting experience in the treatment of intractable oral pain employing the technique of percutaneous radiofrequency thermocoagulation both of the trigeminal and glossopharyngeal nerves. The use of combined percutaneous thermolesions for cancer pain is rarely described in the literature. Immediate and long-term results confirm the usefulness of this surgical procedure.

Disendocrine manifestations during non tumoral aqueductal stenosis.

Disendocrine manifestations during aqueductal stenosis are more and more frequently reported in literature. In the present study, 20 cases of benign aqueductal stenosis associated with disendocrine features as amenorrhea, obesity, polydipsia and polyuria, dwarfism, acromegalic features, hypogonadism, precocious puberty, gigantism are stressed. Authors discuss clinical findings and pathogenetic hypothesis on the base of endocrine, neurological and peculiar radiological features with the support of a wide literature review.

Accidental high voltage electrocution: a rare neurosurgical problem.

The authors describe a case of accidental electrocution from a high voltage current in a young worker, who was struck by the electric shock in the mid-occipital region. The case is especially interesting due to the improbability of anyone surviving after receiving a shock of more than 1000 V., and to the development of bilateral parieto-occipital haemorrhagic infarction with spastic paraparesis, directly caused by the high voltage current and not indirectly by heat generation or secondary head trauma.

Aqueductal stenosis following mumps virus infection. Case report.

A case of aqueductal stenosis following mumps infection is reported, to the authors' knowledge the 12th case in the literature. The pathogenetic events are discussed and the literature reviewed.

Cardiovascular and cerebral complications during glossopharyngeal nerve thermocoagulation.

The cardiovascular and cerebral complications observed during percutaneous radiofrequency thermocoagulation of the glossopharyngeal nerve are described. The value of such symptoms in anticipating a lesion of the vagus nerve is discussed.

[Ischemic cerebrovascular accidents in childhood. Problems of neuroradiological diagnosis]. / Incidenti cerebro-vascolari ischemici in età pediatrica. Problemi di diagnosi neuroradiologica.

The authors present 19 cases of stroke with subsequent hemiplegia in children from 5 months to 15 years of age. These cases are not strictly correlated with haematologic alterations. The aetiopathogenesis remains uncertain in the most of patients, in which predisposing causes are absent and angiographic pictures do not demonstrate anatomical lesions or occlusions of cerebral vessels. In our series, cerebral angiography was performed in 16 children and showed vascular alterations only in 6 cases. CT scan some time after the acute hemiplegia, demonstrated low-density areas in 12 cases over 17 examined, with the characteristic evolution of ischemic lesions.