[Primary angiosarcoma of the aorta]. / Primäres Angiosarkom der Aorta.

Primary angiosarcoma of the aorta is a rare disease. The prognosis is poor, resulting of embolic complications and early metastatic disease, with a median survival of nine months. Diagnosis is difficult and often made post-mortem. We report the case of a 68-year-old woman referred for a thrombosis of the superior mesenteric artery, occurring a few weeks after resection of an angiosarcoma of the small intestine, disclosing a primary angiosarcoma of the aortic wall with metastatic disease.

Spontaneous lateral pontine hemorrhage with associated trigeminal nerve root hematoma.

Spontaneous hemorrhage into the lateral part of the pons with sequelae compatible with survival has been documented previously. The author describes an unusual case with spontaneous hemorrhage into the lateral pons, with intraneural extension into the right trigeminal nerve root. Radiological features were of an expanding mass of the cerebellopontine angle. The patient was treated surgically with success.

Subdural spinal lipoma with posterior fossa extension.

A case is described of subdural spinal lipoma with posterior fossa extension and the world literature is reviewed. A high proportion of high cervical lipomas extend into the posterior cranial fossa. Many cases were probably missed in the pre-computed tomography era. Those cases with posterior fossa growth are more likely to be found in infants or those cases with symptoms dating from birth; most present with quadriparesis. All cases of high cervical lipoma demonstrated by myelography should be submitted to brain computed tomography in order to exclude posterior fossa extension and demonstrate the presence of hydrocephalus.

Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report.

We describe an operative approach to lumbar canal stenosis which, unlike laminectomy, takes into account the segmental pathology of the disease. At each level involved, a bilateral subarticular fenestration is performed under high magnification. The medial third of each facet joint is first removed with an air-powered drill; then the remaining two-thirds of the joint is undercut with the drill to allow a generous fenestration in the thickened ligamentum flavum and adjacent laminae. All tissue responsible for neural compression is removed, but the spinous processes, interspinous ligaments, and much of the facet joints and laminae are preserved. Spinal stability is maintained and, because tissue disruption is minimized, postoperative discomfort is usually reduced, promoting early mobility and reduced hospital stay. The operation is described in detail, and the results of operation in 32 patients are assessed. The follow-up periods now range from 17 to 58 months. Of 23 patients who presented with neurogenic claudication, 14 (61%) obtained complete relief and 7 (30%) improved significantly. The mean hospital stay was 9 days (range, 4 to 17 days).

A direct transnasal approach to the sphenoid sinus. Technical note.

The transsphenoidal route to the pituitary gland is well established in neurosurgical practice, and several approaches to the sphenoidal air sinus have been described. In this paper, the authors describe a technique that utilizes a direct route through the nasal cavity, thereby minimizing disruption of normal tissues.

Surgical treatment of cryptic AVM's and associated hematoma in the brain stem and spinal cord.

Most surgically treated cases of brain-stem hematomas have been attributed to rupture of cryptic arteriovenous malformations (AVM's); however, very few cases have been histologically proven. Similarly, there are very few reports of surgically treated spontaneous hematomyelia, in which the hemorrhage has been histologically confirmed as being due to a purely intramedullary AVM. The authors report three cases with surgically treated, histologically confirmed AVM's, of which two were in the brain stem and the third was in the spinal cord. In all these cases, abnormal vascular tissue in the wall of the hematoma cavity was recognized at operation and excised.