Association between an aneurysm of the anterior inferior cerebral artery and an arteriovenous malformation fed by the same artery.

An unusual case of distal aneurysm of the anterior inferior cerebellar artery (AICA) associated with a cerebellar arteriovenous malformation in a 35 year-old woman is reported. The clinical presentation was a subarachnoid hemorrhage, that is the sudden onset of headache while she was driving her car. In the following days the patient experienced a cerebellopontine angle syndrome: unsteadiness, tinnitus and hearing loss in her left ear, along with drop episodes. All symptoms disappeared in about a week. She consulted a neurosurgeon only a month later. On the day of admission in the Neurosurgical Department of Résidence du Parc Clinic her neurological status was normal. Neuroradiological investigations showed the association between the two distal AICA malformations. At surgery it was possible either to clip the aneurysm or to remove the AVM. The origin of the hemorrhage has not been clearly identified. The patient had an uneventful recovery and returned to her job three months later. The aneurysm was located on the same artery that supplied the AVM. This association is rare at the AICA level. The possible development of the aneurysm induced by increase in flow through the AVM is discussed in the light of Literature data.

Cholesterol granuloma of the cerebello-pontine angle.

An unusual case of cholesterol granuloma of the temporal bone is described presenting as a cerebellopontine tumor. This lesion seemed to arise from an inflammatory process obstructing pneumatized cells. It consists of extradural granulation tissue and must be distinguished from intradural epidermoid cyst, which is, instead, a dysembryogenetic neoplasm. Simple drainage of the granuloma was accomplished by posterior fossa approach, but the lesion recurred after a year. The diagnosis and surgical management of cholesterol granuloma are discussed.

[Vaginal infections in a population of diabetic children and adolescents]. / Infezioni vaginali in una popolazione di bambine e adolescenti diabetiche.

The prevalence of vaginal infections has been evaluated in 51 patient affected by insulin-dependent diabetes (IDDM) and in a control group of girls matched for age. Most frequent infectious agents were Candida Albicans (42.8%) and Streptococcus B (28.5%). No statistical significant relationship was observed between infection and duration of diabetes nor metabolic control, while the relationship was positive between infection and puberty. The peculiarity of this infection during IDDM is stressed and the difficulties in the infection when caused by Streptococcus B are discussed.

Functional pain in hospitalised and school children.

AIM: Aim of the study was to recognise the role of psychological disagreement in children and adolescents suffering from functional pain. METHODS: Two groups of children, adolescents and their parents were interviewed: group H (hospitalized patients), group S (students, at school). Suitable investigations excluded organic lesions. The following data were analysed: 1) presence of pain in relation with: i) sex and age; ii) relation with parents, brothers, other relatives, schoolfellows; 2) efficacy of possible treatments. RESULTS: Group H: 194 patients, median age 10 years; 134 referred pain: 62 out of 92 males and 72 out of 102 females; location of pain: abdomen, limbs, head, back. Family disagreements: 36, functional pain 32; schoolfellows disagreements 114, functional pain 79. Correlations of pain with sex, increasing age, family and schoolfellows disagreements: non statistically significant. Group S: 246 students, median age: 13 years; 188 referred pain: 78 out of 118 males and 110 out of 128 females; pain was statistically more frequent in females, it increased with age. Location of pain: limbs, abdomen, head, back. Family disagreements: 31, functional pain 28, schoolfellows disagreements 140, functional pain 114. Correlations of pain with family and schoolfellows disagreements: non-statistically significant. Several parents gave answers which were different from their children's. Pharmacological and dietary interventions failed to obtain regression of pain. CONCLUSION: In both groups, the referred disagreements were not statistically different among children with functional pain and those without pain; such psychological distress was not the only factor causing functional pain. The empiric treatment adopted was inefficacious.

Management of intramedullary tumours in children.

Clinical presentation, diagnosis, surgical technique and results of 25 cases of intramedullary tumours in patients under 16 years of age are analyzed. Pre-operative spinal deformity was present in 9 patients. Surgery was performed in all. After multilaminectomy with preservation of the intervertebral joints, total removal of the lesion was achieved in 11 patients and subtotal removal in 14 others. After surgery, external immobilization lasting an average period of 5 years was instituted in all patients. Postoperative radiation therapy was performed in 11 cases (5 "high grade" astrocytomas, 5 ependymomas, 1 glioblastoma). There were 11 recurrences: 4 of which (2 ependymomas and 2 "low grade" astrocytomas) were treated surgically, 7 (5 "high grade" astrocytomas, 1 glioblastoma, 1 oligodendroglioma) with palliative radiation treatment. Six patients eventually developed postlaminectomy spinal deformities as diagnosed roentgenographically 6 to 50 months postoperatively. Of the 16 patients still alive, 7 did not present relevant neurological deficit, 1 presented a monoparesis, while the other 8 presented invalidating deficits. Surgical treatment did not differ from that employed in the intramedullary tumours in the adult: radical resection is indeed the optimal therapeutic origin. The risk of radiation therapy are greater in children: it is crucial to limit radiation therapy to only some histotypes. The incidence of spinal column deformity after multilevel laminectomy is greater in young patients. It is advisable to implement prevention of spinal deformities by postoperative external immobilization and constant follow-up so as to detect early changes of spinal stability.