Spinal pigmented villonodular synovitis: a case report.

STUDY DESIGN: This case report illustrates a young male patient with thoracal spinal pigmented villonodular synovitis who presented with difficulty in walking. OBJECTIVES: The treatment of this lesion with posterior approach for preventing neurological deterioration and follow-up with magnetic resonance imaging studies. SUMMARY OF BACKGROUND DATA: Spinal involvement of pigmented villonodular synovitis rare. It is treated by radical surgical excision. But in some cases, as in our case, surgical total excision of the lesion with a one-stage operation is not possible. For this reason, in such cases, follow-up studies with magnetic resonance images are sufficient. This report represents the 14th case of spinal involvement of pigmented villonodular synovitis. METHODS: The patient presented with difficulty walking and received surgery including posterior decompression and subtotal tumor excision. All neurologic signs and symptoms disappeared in a short period. Postoperatively, follow-up studies with magnetic resonance imaging were performed and regrowth of residual lesion was not detected. RESULTS: The patient was discharged home without neurologic deficit. Follow-up studies with magnetic resonance images showed no regrowth of residual lesion. CONCLUSIONS: The principle of surgical management of spinal lesions causing neurologic deficit is early surgical decompression. Although pigmented villonodular synovitis requires total excision, in the presented case total excision of lesion was impossible, because vertebral body involvement needs an anterior or posterolateral approach. During the 16-month follow up, regrowth of the lesion has not occurred. These observations indicate that surgical decompression and follow-up of a patient with magnetic resonance imaging constitute a satisfactory treatment of pigmented villonodular synovitis.

Dumbbell lymphoma of the cervical spine in a child. Case report.

Primary or secondary spinal involvement of lymphoma is a rarely reported entity. An eleven-year-old girl with primary cervical dumbbell non-Hodgkin's lymphoma (NHL) was presented. We could not found any such growth pattern of primary or secondary NHL'S in the literature. For this reason, we reviewed shortly pertinent literature and discussed the pathophysiologic, diagnostic and prognostic features of the lesion with treatment modalities.

Spinal extradural arachnoid cyst.

The case of 16-year-old boy with a spinal extradural arachnoid cyst is presented. An extradural arachnoid diverticulum extending from T10 to L1 was excised totally with hemilaminectomy. Surgery caused prompt improvement of the neurological deficit. The pertinent literature is reviewed.

The human tail associated with intraspinal lipoma: case report.

A case of a tail in a 9-month-old baby is reported. Computed tomography and magnetic resonance imaging clearly demonstrated the presence of spina bifida and lipoma continuous from the tail to the spinal canal. A few medical-historical aspects are discussed. The human tail may be related to spinal dysraphism and requires detailed neuroimaging investigation and microsurgery.

Multiple sclerosis with mass effect: case report.

Multiple sclerosis (MS) may rarely present as a cerebral mass with the clinical features and computed tomography (CT) scan appearance of a cerebral tumor. We report a case of MS with large cranial involvement showing a mass effect. We carried out a complete examination, including contrast enhancement, with neuroimaging studies. The operative procedure associated with medical treatment was performed and we obtained a good result.

Causes of infections and management results in penetrating craniocerebral injuries.

From February 1992 to December 1994, 148 patients with penetrating craniocerebral injuries were treated surgically with primary and secondary debridement including repair of dural defects and removal of retained intracranial bone and metal fragments. Dural defects were closed primarily or with temporalis fascia, pericranium, and cadaver graft. Cerebrospinal fluid fistulas were observed in 11 (7.3%) patients; 7 of these were infected. Central nervous system (CNS) infection was seen in 2 patients without CSF fistula. Excluding those 11 patients with CSF fistula CNS infection was shown in 2 of the 137 cases (1.5%). All patients underwent CT scans periodically. In 51 (34%) of 148 patients, bone and metal fragments were determined on control CT scans. During this time, 12 patients died (8%). Most of deaths were caused by the direct effect of brain injury and occurred within the first month after injury. Fragments retained after first debridement were followed periodically by CT scan. Surgery was not performed until infection developed. Retained fragments did not increase the infection risk, but high rates of infection did occur in cases with CSF fistula.

Cyst of the mesencephalon (neuroepithelial cyst?): review and case report.

A case of a mesencephalic region cyst is reported. Neuroepithelial cysts are rare benign lesions that may be asymptomatic or may appear as space-occupying mass lesion. The pathogenesis and principles of diagnosis and management of these rare lesions are reviewed.

Nerve entrapment by a firmly wrapped Baker cyst.

Baker's cysts as a clinical entity are among the most infrequent cause of peripheral nerve entrapment and usually produce a strong positive pressure within the knee resulting in the rupture of the joint capsule. An unusual case with muscular and sensorial weakness due to compression of the peroneal nerve around the fibular head by a Baker cyst is presented in this article. Clinical and electromyographical findings shown peroneal nerve entrapments in the popliteal fossa. Peroneal nerve decompression by synevectomy resulted in clinical and electromyographical improvement.

Foot drop following brain tumors: case reports.

Three cases with foot drop following brain tumors in patients suffering from parasagittal pathology are reported. Foot drop was the first complaint in the patients in our series. We generally notice foot drop as a sign of lumbar disc herniation or peroneal nerve lesions but rarely foot drop may also occur with brain lesions.

Primary multiple cerebral hydatid cysts: case report with CT and MRI study.

We present a case of a patient with multiple cerebral hydatidosis. We could not find any other origin of hydatidosis. In the light of the radiodiagnostic and biochemical findings, we assessed this case as a primary cerebral hydatidosis. The cysts were delivered completely. Two months after operation, the patient's neurological examination and control MRI were normal.

Outcome analyses in 1072 surgically treated lumbar disc herniations.

This article reports the outcomes of 1072 consecutive patients surgically treated during a ten-year period. There are many new techniques for the treatment for lumbar disc hernia, but also the conventional standard discectomy procedure is still the most acceptable method today. 1072 consecutive, non-randomized patients with lumbar disc herniation were reviewed for a clinical retrospective study about the surgical outcome according to our functional grading system. The patients reported ruptured disc to be due to lifting (30.13%), trauma (9.42%), and sports (8.11%). Almost all patients had complained of radicular pain in a dermatomal distribution (90.39%) and 86.07% had low-back pain, 5.2% of the patients had complications. Eighty-five patients (7.92%) had a second lumbar disc operation. Thirty of these eighty-five patients underwent the operation at the same level. Patients were also rated to improve the ability. Almost 91% of the patients had excellent, good, and satisfactory outcome; 9% of patients had moderate and poor categories of outcome. Several conclusions can be drawn from this large series of patients who were operated for lumbar disc herniation. 1. Most patients had good-to-excellent surgical outcomes after lumbar discectomy. 2. The results of disc surgery depend not only upon operative technique and skill, the degree of neurological impairment but also upon the correct selection of cases.