Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 800
Filtrar
1.
Nat Commun ; 11(1): 354, 2020 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-31953399

RESUMO

The mechanisms behind molecular transport from cerebrospinal fluid to dural lymphatic vessels remain unknown. This study utilized magnetic resonance imaging along with cerebrospinal fluid tracer to visualize clearance pathways to human dural lymphatics in vivo. In 18 subjects with suspicion of various types of cerebrospinal fluid disorders, 3D T2-Fluid Attenuated Inversion Recovery, T1-black-blood, and T1 gradient echo acquisitions were obtained prior to intrathecal administration of the contrast agent gadobutrol (0.5 ml, 1 mmol/ml), serving as a cerebrospinal fluid tracer. Propagation of tracer was followed with T1 sequences at 3, 6, 24 and 48 h after the injection. The tracer escaped from cerebrospinal fluid into parasagittal dura along the superior sagittal sinus at areas nearby entry of cortical cerebral veins. The findings demonstrate that trans-arachnoid molecular passage does occur and suggest that parasagittal dura may serve as a bridging link between human brain and dural lymphatic vessels.


Assuntos
Líquido Cefalorraquidiano/metabolismo , Dura-Máter/metabolismo , Vasos Linfáticos/metabolismo , Adulto , Idoso , Aracnoide-Máter/metabolismo , Transporte Biológico/fisiologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Líquido Cefalorraquidiano/diagnóstico por imagem , Meios de Contraste , Dura-Máter/diagnóstico por imagem , Dura-Máter/patologia , Humanos , Sistema Linfático/fisiologia , Vasos Linfáticos/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Compostos Organometálicos , Adulto Jovem
2.
World Neurosurg ; 134: e866-e873, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31715409

RESUMO

OBJECTIVE: To assess the dynamic change of the dural sac size in patients with lumbar spinal stenosis (LSS) from supine to standing position and their correlation with clinical symptoms. METHODS: A total of 110 patients with LSS were prospectively enrolled to undergo both supine (0°) and standing (78°) magnetic resonance imaging (MRI). Dural sac cross-sectional area (DCSA) and dural sac anteroposterior diameter (DAPD) at the most constricted spinal level in supine and standing MRI were measured and compared. Clinical symptoms were assessed by duration of disease, claudication distance, visual analog scale (VAS) score of leg pain, and Chinese Oswestry Disability Index score of low back pain. The correlation between the parameters and clinical symptoms was analyzed by Pearson correlation coefficient (r). RESULTS: Mean minimum DCSA and DAPD in the standing position were significantly smaller (both P < 0.01) than in the supine position. DCSA and DAPD in standing MRI and their changes had better correlation with the intermittent claudication distance and VAS score of leg pain than in the supine position. A more than 15 mm2 reduction of DSCA was observed in patients with shorter claudication distance and more severe VAS score of leg pain (both P < 0.01). CONCLUSIONS: Dural sac size on MRI was reduced significantly from supine to standing position. Standing MRI and the changes of DCSA significantly correlated with claudication distance and VAS score of leg pain in patients with LSS. Therefore, standing MRI provides more radiologic information correlating with clinical symptoms in patients with LSS than supine MRI.


Assuntos
Dura-Máter/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Posição Ortostática , Decúbito Dorsal , Adulto , Idoso , Dura-Máter/patologia , Feminino , Humanos , Perna (Membro) , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Dor/etiologia , Dor/fisiopatologia , Medição da Dor , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia
3.
World Neurosurg ; 133: 29-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526887

RESUMO

BACKGROUND: Spinal dural arteriovenous fistula (DAVF) typically has a single intradural drainage vein, abnormally connecting with the radiculomeningeal artery at the dura root sleeve. Multiple intradural draining veins are extremely rare. To date, only 1 case of spinal DAVF with multiple draining veins has been reported. CASE DESCRIPTION: A 62-year-old woman presented with a 2-year history of progressive weakness and numbness in her lower extremities. Spinal magnetic resonance imaging showed extensive edema of the cord and prominent vascular flow voids. Spinal angiography demonstrated a right L3 DAVF with supply from the left L3 lumbar artery. The feeding artery was also thought to give rise to the artery of Adamkiewicz. The spinal DAVF was surgically treated, and the artery of Adamkiewicz was retained. Her postoperative symptoms gradually improved. Eight months after the surgery, her symptoms gradually worsened. Repeat spinal angiography revealed a right L3 DAVF at the same location of the first fistula. In retrospect, the draining vein identified on the second angiography was mistakenly considered as the artery of Adamkiewicz at the first angiography. Therefore the initial fistula was drained through double draining veins, 1 of them mimicking the artery of Adamkiewicz. The fistula was coagulated and divided. Postoperatively, the patient's symptoms gradually improved. Three months after the second surgery, she was able to walk independently. CONCLUSIONS: Spinal DAVF is a rare disease, but clinicians should be cautious of possible multiple drainage veins in diagnosis and treatment.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Dura-Máter/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Angiografia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Dura-Máter/irrigação sanguínea , Dura-Máter/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Doenças da Medula Espinal/cirurgia
4.
Maturitas ; 132: 35-39, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31883661

RESUMO

OBJECTIVES: The use of vitamin K antagonists (VKA) is associated with the onset of vascular and soft-tissue calcifications. Whether there are more intracranial calcifications under VKA remains unclear. The objective of this study was to determine whether the regular use of VKA in older adults was associated with an increased burden of intracranial calcifications compared with the use of direct oral anticoagulant (DOA). STUDY DESIGN: Nineteen patients aged 70 years or more using VKA for more than 3 months and 19 controls (matched for age, gender and indication for anticoagulation) using DOA for more than 3 months were consecutively included in this study. MAIN OUTCOMES MEASURES: The burden of intracranial calcifications was graded by an experienced neuroradiologist from 0 (no burden) to 3 (high burden) according to the quantity, size, intensity and confluence of calcifications on computed tomography scan of the brain. Age, gender, frontal assessment battery (FAB) score, hypertension, dyslipidaemia, carotid artery stenosis, kidney failure and indication for anticoagulation were investigated as potential confounders. RESULTS: The 19 patients using VKA (median[IQR], 84years[7]; 10females) exhibited a greater burden of falcian calcifications than the 19 controls using DOA (respectively, 2[1] versus 1[2], P = 0.025). Overall, we found that using VKA was directly associated with the global burden of intracranial calcifications (ß = 1.54, P = 0.049). No correlation was found with calcifications in sites other than the falx cerebri. CONCLUSIONS: The use of VKA was associated with a greater burden of intracranial calcifications compared with the use of DOA, specifically in the falx cerebri. This finding may explain part of the neurocognitive morbidity met with VKA.


Assuntos
Anticoagulantes/efeitos adversos , Encefalopatias/induzido quimicamente , Calcinose/induzido quimicamente , Vitamina K/antagonistas & inibidores , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Encefalopatias/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Dura-Máter/diagnóstico por imagem , Feminino , França , Humanos , Masculino , Tomografia Computadorizada por Raios X
5.
Tidsskr Nor Laegeforen ; 139(18)2019 Dec 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31823568

RESUMO

BACKGROUND: An active man in his fifties was treated for atrial fibrillation with ablation. One week later he noticed variable weakness in his lower extremities. In the days that followed, his symptoms improved but could vary from day to day. CASE PRESENTATION: On admission 3 months after the initial symptoms, he had spasticity and weakness in both lower extremities, with hyperreflexia and positive Babinski. Spinal fluid contained slightly elevated protein levels. Spinal MRI showed cord oedema and gadolinium enhancement over multiple spinal levels. Autoimmune myelitis was suspected, and he was treated with high dose steroids and rituximab. Due to lack of effect, repeated examinations were initiated. Information from his patient history regarding symptom exacerbation by walking or bending forward was emphasised. Repeated MRI showed unchanged spinal oedema and dilated peri- and intramedullary vessels. MRA and spinal digital DSA revealed a dural fistula at third lumbar level, with the left L3 radiculomedullary artery as the feed artery. The fistula was successfully ligated by the neurosurgeon. INTERPRETATION: Spinal vascular lesions are rare and the diagnosis may be challenging due to atypical presentation. The case shows that detailed information from the patient history and thorough clinical investigation is of paramount importance to disclose this probably underreported condition.


Assuntos
Dura-Máter , Fístula , Meios de Contraste , Dura-Máter/diagnóstico por imagem , Fístula/diagnóstico por imagem , Gadolínio , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Debilidade Muscular , Caminhada
6.
Neuropathology ; 39(6): 461-466, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31584218

RESUMO

Chondroma is a benign cartilage-forming tumor which usually occurs in small bones of extremities but occasionally occurs in the brain. Usually, intracranial chondromas originate from skull base; however, chondroma of the falx cerebri is a very rare condition. We here report a rare case of falcine chondroma in a 19-year-old man who had normal physical examination without signs of any syndromic disorder. The neuroimaging findings were inconclusive, and the diagnosis was based on histopathological examination. The purpose of this paper is to raise attention about intracranial chondromas and suggest that chondroma must be ruled out in any patient presenting with masses arising from the falx.


Assuntos
Condroma/diagnóstico por imagem , Condroma/cirurgia , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Humanos , Masculino , Adulto Jovem
7.
J Orthop Sci ; 24(6): 979-984, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537426

RESUMO

BACKGROUND: To investigate dural sac enlargements and spinal alignments in patients who underwent indirect decompression with interspinous spacers. METHODS: The subjects were 20 patients who underwent indirect decompression using an interspinous spacer (X-STOP) without laminectomy. Of these 20 patients, 1 patient underwent implant removal surgery 1 month after X-STOP surgery and two patients dropped out. Ultimately, 17 patients were included in this study. MRI and X-ray images were investigated before surgery, 1 week after surgery, 3 months after surgery, and 2 years after surgery. RESULTS: On MRI, the mean cross-sectional areas of the dural sac were 52.7 mm2 before surgery, 73.2 mm2 1 week after surgery, 62.4 mm2 3 months after surgery, and 58.3 mm2 2 years after surgery. There was a significant 37% increase at 1 week postoperatively compared with that before surgery, but there were no significant differences between 3 months postoperatively and 2 years postoperatively. The disc angle in an extension posture was significantly decreased at 1 week after surgery compared with that before surgery, but there were no significant differences between before surgery, 3 months after surgery, and 2 years after surgery. CONCLUSIONS: The interspinous process spacer increased the dural sac area by 37% 1 week after surgery, but the enlargement was not maintained at 3 months or 2 years after surgery. The use of interspinous process spacers produced an enlargement of the dural sac by limiting extension of the stenotic level only. However, its effect diminished 2 years after surgery.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Dura-Máter/patologia , Próteses e Implantes/efeitos adversos , Estenose Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Hipertrofia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estenose Espinal/diagnóstico por imagem
8.
Clin Lab ; 65(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31532104

RESUMO

BACKGROUND: The Cavernous Angioma in Posterior Sagittal Sinus is exceedingly rare. METHODS: We report for the case of a 10-year-old male patient who was diagnosed with Cavernous Angioma in Posterior Sagittal Sinus. RESULTS: Our case is the second reported case of Cavernous Angioma in Posterior Sagittal Sinus in the world. CONCLUSIONS: It is very rare for the cavernous hemangioma to occur in the sinus, preoperative conventional MR scan lacks specificity and easily leads to misdiagnosis. Head MR enhancement, MRBTI, and SWI can provide more useful diagnostic information. The final diagnosis depends on the pathology examination.


Assuntos
Seio Cavernoso/patologia , Dura-Máter/irrigação sanguínea , Hemangioma Cavernoso/diagnóstico , Neoplasias Meníngeas/diagnóstico , Seio Cavernoso/diagnóstico por imagem , Criança , Dura-Máter/diagnóstico por imagem , Hemangioma Cavernoso/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
9.
BMC Musculoskelet Disord ; 20(1): 408, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484514

RESUMO

BACKGROUND: Mesenchymal chondrosarcoma (MCS) is a rare malignant variant of chondrosarcoma with a high tendency of recurrence and metastasis. Intradural extramedullary spinal MCS is exceedingly rare and usually found in pediatric patients. Herein, we present an elderly patient with primary intradural extramedullary spinal MCS. Relevant literatures are reviewed to disclose characteristics of intradural extramedullary spinal MCS. CASE PRESENTATION: A 64-year-old female presented with urinary difficulty and tightness of upper back preceding progressive weakness of right lower extremity. Magnetic resonance imaging revealed an intradural extramedullary tumor at the level of 3rd thoracic vertebra. This patient underwent total tumor resection and then received adjuvant radiotherapy. Histopathological examination showed that the tumor composed of spindle and round cells with high nucleocytoplasmic ratio accompanied by scattered eosinophilic chondroid matrix. Along with immunohistochemical findings and the existence of HEY1-NCOA2 fusion transcript, the diagnosis of MCS was confirmed. Neurologic deficit recovered nearly completely after surgery. No evidence of local recurrence or distant metastasis was found 5 years after treatments. Including the current case, a total of 18 cases have been reported in the literature with only one case with local recurrence and one case of mortality. The current case was the eldest patient diagnosed with primary intraspinal MCS in the literature. CONCLUSIONS: MCS rarely appears in the intradural space of the spine. In contrast to classic MCS, treatment outcome of primary intradural extramedullary spinal MCS is usually excellent as total tumor resection is commonly achievable. Adjuvant radiotherapy may reduce local recurrence and chemotherapy may be associated with fewer recurrences especially for unresectable tumors.


Assuntos
Condrossarcoma Mesenquimal/diagnóstico , Dura-Máter/patologia , Neoplasias da Medula Espinal/diagnóstico , Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Proteínas de Ciclo Celular/genética , Condrossarcoma Mesenquimal/genética , Condrossarcoma Mesenquimal/terapia , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Feminino , Humanos , Laminectomia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Coativador 2 de Receptor Nuclear/genética , Radioterapia Adjuvante , Neoplasias da Medula Espinal/genética , Neoplasias da Medula Espinal/terapia , Fusão Vertebral , Resultado do Tratamento
10.
Turk Neurosurg ; 29(6): 875-886, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31452176

RESUMO

AIM: To identify the range of dimensional morphometric variability correlated to the basilar and condylar part of the occipital bone, which may affect the choice of approach to ventral intradural foramen magnum (FM) lesions. MATERIAL AND METHODS: In total, 25 dry skulls and 50 head computed tomography (CT) scan results have been assessed in detail, focusing on the FM, occipital condyles, jugular tubercles (JT), and hypoglossal canals (HC). A morphometric analysis has been carried out using linear and angular measurements to estimate the range of the dimensional variability of these structures. Data were presented as mean ± standard deviation, ranges, and interquartile range on a boxplot. The sagittal intercondylar angle (SICA) and anterior condylar angle (ACA) have been found to be important in estimating the axial orientation of the condyles, whereas the JT-HC interline ratio has indicated the prominence of the tubercles. RESULTS: The SICA and ACA have exhibited high variability. The average JT-HC interline ratio was 0.8. Wider SICA-ACA and higher JT-HC interline ratio make the posterolateral approach advantageous. An anterior medial or far-medial endoscopic route is indicated in opposite conditions. In this study, two illustrative cases have been reported. CONCLUSION: A cautious preoperative morphometric evaluation of the FM region must be considered prior to using tailored and safe anterior endoscopic and posterolateral approaches to ventral intradural lesions to identify the advantages of a certain corridor as much as possible, thereby minimizing the risk of complications.


Assuntos
Dura-Máter/diagnóstico por imagem , Forame Magno/diagnóstico por imagem , Osso Occipital/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Dura-Máter/patologia , Dura-Máter/cirurgia , Feminino , Forame Magno/patologia , Forame Magno/cirurgia , Humanos , Masculino , Osso Occipital/patologia , Osso Occipital/cirurgia
11.
Spine (Phila Pa 1976) ; 44(24): E1411-E1418, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31365515

RESUMO

MINI: On magnetic resonance imaging, indirect decompression using lateral lumbar interbody fusion and posterior fixation was confirmed immediately after surgery and also continuously progressed after surgery, particularly during the first 6 months. Thecal sac enlargement was also confirmed, and is suspected to be caused by the atrophy of the ligamentum flavum and the disc. STUDY DESIGN: A prospective cohort study. OBJECTIVE: The aim of this study was to investigate radiographical changes related to indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation. SUMMARY OF BACKGROUND DATA: Indirect lumbar decompression via LLIF is used to treat degenerative lumbar diseases requiring neural decompression. Although evidence suggests that thecal sac enlargement follows shortly after surgery, few studies have described the postoperative changes on MRIs. METHODS: This study involved 102 patients who underwent indirect decompression at 136 levels, with LLIF and posterior fixation. Magnetic resonance imaging (MRIs) were collected preoperatively and several times postoperatively (over a 2-year period starting immediately after surgery). We then quantified the cross-sectional areas of the thecal sac and ligamentum flavum, as well as the anteroposterior diameter of disc bulging, and qualitatively assessed lumbar spinal stenosis according to a modified version of Schizas' classification [Grades A (mild) to C (severe)]. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for the assessment of the clinical symptoms. RESULTS: All changes were observable immediately after surgery, progressed over time, and were significantly different statistically at 2 years after surgery. The thecal sac was significantly larger (189% of preoperative; P < 0.0001), while the ligamentum flavum and disc bulge were significantly smaller [58.9% and 67.3% of preoperative (P < 0.001), respectively]. The number of patients with grade C (severe) lumbar stenosis also dropped significantly (preoperative, 17.6%; 2 years postoperative, 0%). There were no significant differences in JOABPEQ results at 6 months, 1 year, and 2 years postsurgery. CONCLUSION: Indirect decompression produces immediate positive results that continue to improve over time. The cross-sectional area of the thecal sac doubled by 2 years after surgery, and the ligamentum flavum cross-sectional area and disc bulging both shrank significantly. At the same time, however, postoperative radiographical improvements do not appear to correlate with clinical symptoms. LEVEL OF EVIDENCE: 3.


Assuntos
Descompressão Cirúrgica/métodos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico por imagem , Idoso , Dor nas Costas/etiologia , Dura-Máter/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Ligamento Amarelo/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Medição da Dor , Período Pós-Operatório , Estudos Prospectivos
13.
Neuroradiology ; 61(10): 1203-1208, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31396663

RESUMO

We herein present three cases of a rare type of spinal AVF, an intradural radicular AVF, which mimicked a dural AVF. A 65-year-old male presented with congestive myelopathy. On angiography, right vertebral angiogram (VAG) showed a suspected dural AVF; however, left VAG showed the same intradural dilated vein fed by the anterior spinal artery (ASA). Intraoperative and histological results suggested that a single AVF was located on the right C1 nerve root fed by the right C1 radicular artery and branch of the anterior spinal artery. Two additional patients with a radicular AVF at the C3 or C5 level were presented. Intradural radicular AVFs and dural AVFs have very similar appearances; however, there is a difference that makes the risk of the endovascular treatment of radicular AVFs markedly higher because of blood supply from the ASA. In our case, the AVF was completely occluded by direct surgery without major complications.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Dura-Máter/irrigação sanguínea , Dura-Máter/diagnóstico por imagem , Raízes Nervosas Espinhais/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Angiografia , Malformações Vasculares do Sistema Nervoso Central/patologia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Diagnóstico Diferencial , Dura-Máter/patologia , Dura-Máter/cirurgia , Humanos , Masculino , Raízes Nervosas Espinhais/irrigação sanguínea , Raízes Nervosas Espinhais/patologia , Raízes Nervosas Espinhais/cirurgia
14.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 198-201, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183587

RESUMO

El Pott's puffy tumor (PPT) es una rara entidad que en la actualidad representa un abombamiento del cuero cabelludo asociado a un absceso subperióstico y a una osteomielitis craneal, pudiendo acompañarse o no de infección intracraneal. Suele asociarse a la sinusitis frontal, tratándose de una complicación típica, aunque poco frecuente de la misma. Por su parte las osteomielitis causadas por Actinomyces son raras y suelen tener lugar a nivel mandibular, no encontrándose apenas casos de osteomielitis craneal causada por este género bacteriano, en especial tras traumatismo craneoencefálico. Presentamos un caso especialmente poco usual al tratarse de un PPT frontal tras traumatismo cerrado, con componente intracraneal y en el que tras cirugía se aisló Actinomyces como copartícipe de dicha infección, junto con Fusobacterium y Propionibacterium


Pott's puffy tumour (PPT) is a rare entity that involves scalp swelling associated with subperiosteal abscess and cranial osteomyelitis, occasionally accompanied by intracranial infection. It is usually affiliated with frontal sinusitis, which is a typical but infrequent complication. On the contrary, Osteomyelitis by Actinomyces is rare and usually occurs at the mandibular level, with very few cases of cranial osteomyelitis caused by this bacterial specie, especially after traumatic brain injury. We report an exceptionally unusual case of a PPT frontal tumor after blunt trauma (closed head injury), with an intracranial lesion whereby Actinomyces was isolated after surgery, as a co-participant of the mentioned infection besides Fusobacterium and Propionibacterium


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Osteomielite/complicações , Actinomyces/patogenicidade , Actinomyces/isolamento & purificação , Osso Frontal/diagnóstico por imagem , Osso Frontal/lesões , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Antibacterianos/administração & dosagem
16.
World Neurosurg ; 130: 506-511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349075

RESUMO

BACKGROUND: Angioleiomyoma (ALM) is a soft tissue neoplasm rarely described in the intracranial site. Because of their uncommon presentation, atypical neuroradiologic and pathologic features, ALMs are often misdiagnosed. CASE DESCRIPTION: We describe the neuroradiologic, clinical, and pathologic data of a 37-year-old male patient suffering from a tentorial ALM. He was admitted at our hospital because of a posterior cranial fossa mass. Magnetic resonance imaging (MRI) showed a left tentorial tumor, hypointense on T1-weighted sequences, with heterogeneous contrast enhancement after gadolinium injection ("salt-and-pepper" fashion) and slightly hyperintense signal on T2-weighted sequence. After surgery, pathological examination showed a tumor composed of several thick-walled blood vessels mixed with a population of deeply eosinophilic spindle-shaped smooth muscle cells arranged in bundles. Necrosis was absent. Neither cellular pleomorphism nor mitoses were detected. Immuno-histochemical analysis confirmed the smooth muscle phenotype of the spindle cell component: diffuse and strong positivity for alpha-smooth muscle actin, desmin, and h-caldesmon. Based on both morphologic and immunohistochemical findings, a diagnosis of primary intracranial ALM was rendered. CONCLUSIONS: We add to the literature the tenth case of this exceedingly rare tumor and submit that ALM should be suspected when a tentorial mass with a "flame-like" time-dependent pattern of contrast enhancement on MRI, a "salt-and-pepper" post-contrast appearance on MRI T1-weighted sequences, and a relation with large intracranial feeding vessels are present.


Assuntos
Angiomioma/diagnóstico , Angiomioma/patologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patologia , Adulto , Angiomioma/complicações , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/complicações , Dura-Máter/diagnóstico por imagem , Dura-Máter/patologia , Humanos , Masculino , Neoplasias Meníngeas/complicações
17.
World Neurosurg ; 130: 10-12, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254692

RESUMO

Oligodendrogliomas, the third most common primary gliomas, have a strict molecular definition, characterized by the combined presence of isocitrate dehydrogenase mutation and 1p19q codeletion. Herein, we describe an extremely unusual case of molecularly defined anaplastic oligodendroglioma with transdural extension into the frontal and ethmoid sinuses, without prior neurosurgical intervention or radiotherapy. The molecular profile of the tumor is also provided. To the best of our knowledge, this has never been reported before. Most of the previously reported glial tumors with transdural extension were cases of histologically proven glioblastomas and gliosarcomas, typically seen in the context of prior neurosurgical intervention and/or radiotherapy. This case adds to the limited literature on oligodendrogliomas with transdural extension. Further studies are necessary to elucidate the relationship between the incidence of transdural extension and molecular subtypes of oligodendrogliomas.


Assuntos
Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Oligodendroglioma/diagnóstico por imagem , Oligodendroglioma/cirurgia , Adulto , Humanos , Masculino
18.
BMC Musculoskelet Disord ; 20(1): 296, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31221132

RESUMO

BACKGROUND: Intraspinal gas pseudocyst is rare, especially following spinal surgery. Here we present a case of spinal epidural gas pseudocyst following lumbar decompression surgery, which caused dura sac compression. CASE PRESENTATION: A 52-years-old woman with chronic lumbar pain and radiating numbness of left leg was admitted to our hospital and underwent a posterior lumbar decompression surgery. 10 days later, the patient began to have dysfunction of excretion. CT and MRI were taken and epidural gas was detected, which compressed the dura sac. A huge pseudocyst encapsulated with high-tension air was found during debridement with no evidence of infection. RESULTS: Debridement surgery was taken to remove the encapsulated gas and cyst wall and her symptoms disappeared soon after the surgery. 2 weeks later, routine X-ray was repeated and gas pseudocyst disappeared with no signs of infection. CONCLUSION: Gas pseudocyst in the spinal canal is rare, especially after lumbar surgery and causing spinal cord compression. CT and MRI can be used to detect the spinal gas. Once gas pseudocyst causes dura sac compression, proper methods should be chosen to treat this kind of intraspinal gas pseudocyst.


Assuntos
Cistos/diagnóstico , Descompressão Cirúrgica/efeitos adversos , Dura-Máter/patologia , Complicações Pós-Operatórias/diagnóstico , Fusão Vertebral/efeitos adversos , Cistos/etiologia , Cistos/cirurgia , Desbridamento , Descompressão Cirúrgica/instrumentação , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/patologia , Espaço Epidural/cirurgia , Feminino , Gases , Humanos , Dor Lombar/cirurgia , Vértebras Lombares , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/instrumentação
19.
World Neurosurg ; 128: 385-389, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31121367

RESUMO

BACKGROUND: Intradural lumbar disc herniation is rare, with an incidence of 0.3%-1%, but has been well reported in the literature. Transdural migration of the disc penetrating both ventral and dorsal dura is extremely rare, and there is a dearth of literature in the pathophysiology and surgical management of transdural herniation. Lack of knowledge on this type of presentation can cause intraoperative surprises and inadvertent cauda equina root injuries and lead to prolonged operative time. We report 1 such case, describe our surgical experience, and discuss the pathological mechanisms and signs. CASE DESCRIPTION: A 30-year-old woman presented to outpatient clinic with chronic cauda equina syndrome due to massive L4-L5 disc herniation. L4-L5 decompression and transforaminal lumbar interbody fusion were planned. Unexpectedly, however, surgery revealed a transdural herniation, which was effectively managed with laminectomy, extension of durotomy, discectomy, repair of both dorsal and ventral dura, and interbody fusion, but at the expense of prolonged surgical time. CONCLUSIONS: Transdural herniation of a lumbar disc is very rare presentation. It can be effectively managed with laminectomy, extension of durotomy, discectomy and repair of both dorsal and ventral dura. It can be diagnosed by magnetic resonance imaging preoperatively only if read with suspicion of such presentation.


Assuntos
Síndrome da Cauda Equina/cirurgia , Dura-Máter/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Adulto , Síndrome da Cauda Equina/etiologia , Descompressão Cirúrgica , Discotomia , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Laminectomia , Vértebras Lombares , Duração da Cirurgia , Fusão Vertebral
20.
World Neurosurg ; 128: 289-294, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102769

RESUMO

BACKGROUND: Ganglioneuroma is a well-differentiated benign tumor that develops from the ganglion cells of the posterior mediastinum, retroperitoneum, cervical spine, and adrenal glands. The paravertebral body, in which the sympathetic trunk exists, is a common tumor site, and tumor sometimes invades the spinal canal through the intervertebral foramen. There have been no reports regarding tumors with intradural and extradural continuity. We report a paravertebral ganglioneuroma extending between the intradural and extradural spaces and its surgical treatment. CASE DESCRIPTION: A 33-year-old man was admitted to the hospital with progressive left lower limb numbness. A dumbbell-type tumor progressing to the spinal canal via the left intervertebral foramen from the paravertebral body at L1-2 was detected, and intradural calcified lesions were found. Pathologic examination of a computed tomography-guided biopsy sample revealed a ganglioglioma. The extradural tumor was removed; however, the left lower limb pain gradually worsened. As complete block was observed on myelography, the intradural tumor was removed 8 months later. Intraoperative findings revealed that the intradural and extradural tumors were continuous through the L1 nerve root. CONCLUSIONS: This is the first known reported case of paravertebral ganglioneuroma presenting in continuity between the intradural and extradural spaces.


Assuntos
Dura-Máter/diagnóstico por imagem , Ganglioneuroma/cirurgia , Vértebras Lombares/cirurgia , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Ganglioneuroma/diagnóstico por imagem , Humanos , Biópsia Guiada por Imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Nervos Espinhais/diagnóstico por imagem , Nervos Espinhais/cirurgia , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA