Chronic encapsulated intracerebral hematoma: contribution of thallium-201 single photon emission computed tomography in preoperative diagnosis: case report.

OBJECTIVE AND IMPORTANCE: Chronic encapsulated intracerebral hematoma is a fairly rare clinical entity. This unique lesion is peculiar for its clinical onset, formation of a capsule, and progressive enlargement. The mechanism for capsule formation and self-perpetuating expansion still remains uncertain, as well as the causal relationship with vascular malformations. Because of their pseudotumoral course and misleading neuroradiological features, these lesions can be misdiagnosed preoperatively as cerebral neoplasms. CLINICAL PRESENTATIONS: A 62-year-old man was referred with a 2-month history of generalized tonicoclonic seizures. There was no history of head injury or arterial hypertension. The results of a neurological examination were normal. Computed tomographic scans revealed a slightly hyperdense roundish area in the right parietotemporal region with ring-like enhancement after contrast medium injection, moderate mass effect, and perifocal low attenuation. With the provisional diagnosis of astrocytoma, the patient was admitted for a craniotomy. Before surgery, a thallium-201 single photon emission computed tomographic study was performed, which showed no abnormal uptake of the tracer, raising significant doubt regarding the presumptive diagnosis of a tumor. INTERVENTION: Intraoperative findings revealed a hematoma, with a well-demarcated, thick, fibrous-elastic capsule. There was evidence of repeated intracapsular hemorrhages. The lesion was totally removed, and the patient recovered fully. No other pathological findings, including vascular malformations, were noted. CONCLUSION: Chronic encapsulated intracerebral hematomas probably occur more frequently than the limited number of reported cases would indicate. This case represents a realistic clinical problem-solving setting in with thallium-201 single photon emission computed tomography was used because of its capacity for functional tumor detection and differential diagnosis.

Considerations on the operative results in a group of elderly neurosurgical patients.

536 patients from 60 to 84 years old, operated on for neurosurgical lesions, are evaluated with reference to post-operative mortality rate related to the type of pathology. 83 deaths (15.6%) occurred in this series. Mortality rate increases progressively with advancing age. It is outlined that the aged patients have lesser chances of surgical success, but the present data induce to consider with greater favour the outcome of these patients.

Optical-chiasmatic region epidermoid with a suprasellar and prepontina region cysticercosis.

The Authors report a case of epidermoid in the optical-chiasmatic region associated with a cysticercosis in the suprasellar and prepontal region. The patient was surgically treated with success: a bilobate cystic formation with ramifications adherent to the carotid siphon was found in front of optic nerves. Opening the arachnoid between the left optic nerve and carotid, a dysembriogenetic cystic formation was observed. Adherent to it there was the wall of a second parasitic cystic formation (probably cysticercosis) from which some small cysts slid away. After a review of the literature the Authors point out both the casual association of the two pathologies and the utility of C.T. scan in the diagnostic process of the above mentioned lesions.

Median third ventricle meningioma. Case report.

A case of meningioma located in the median part of the third ventricle and revealed by autoptic examination in a patient who died for meningoencephalitis is reported.

Peritumoral subarachnoid hemorrhage in microsurgical transitional interface type meningioma: may the interface play a role?

The evidence of an intracranial hemorrhage from a meningioma, in comparison with bleeding from different intracranial tumours, is very infrequent. The pathophysiological mechanisms that can explain the possibility of bleeding from meningiomas have not been yet completely clarified. We report a case of a left parasagittal meningotheliomatous meningioma, situated in the premotor cortex, presenting with a peritumoral hemorrhage, at the interface between the meningioma and the brain parenchyma, and strictly confined within the subarachnoid space. A detailed immunohystochemical study of the tumour was performed. The neuroradiological and neurosurgical analysis of the tumour-to-brain interface, served to understand the pathophysiology of this uncommon behaviour. Other possible pathomechanisms explaining bleeding from meningiomas, in the light of the more recent literature are discussed.

[Traumatic obliteration of the middle cerebral artery. Pathogenic considerations]. / Oblitération traumatique de l'artère cérébrale moyenne. Considérations pathogéniques

Report on one case of traumatic obliteration of the middle cerebral artery together with a review of the pathogenetic theories published till presently on this subject. Three factors are retained in the case object of the present work: --compression of the arterial wall in the Sylvian fissure, as a consequence of contusion and cerebral edema, --disorders in the platelets aggregation, --high blood pressure.

[Giant aneurysm of the sylvian artery in a 4-year old child (exeresis, remission)]. / Anévrysme géant de lártère sylvienne chez un enfant de quatre ans (exérèse, guérison)

The AA. describe a case of a giant aneurysm 6 centimeters in diameter in a child of 4 years old. The lesion was made evident on the occasion of an hemorrhage that has caused an insular hematoma. The patient has undergone an operation with favourable outcome. The lack of neurologic symtomatology until the moment of the hemorrhage lead the AA. to think that this lesion was of the notables proportions from the moment of birth, so that the cerebral parenchyma was modeled on it. Unlike others cases in litterature recogniset, the wall of the aneurysmatic bag did not present fibrotics thickenings, and besides the blood-clot included in it seemed histologicaly of recent formation.

[Experimental fetal hydrocephalus. Ventriculo-amniotic shunt]. / Hydrocéphalie foetale expérimentale. Shunt ventriculo-amniotique.

When the original idea was conceived 8 years ago to develop a surgical technique for the treatment of fetal hydrocephalus, the pathway towards prenatal surgery for this affection was totally unexplored. The operation appeared to be feasible because of the possibility of a ventriculo-amniotic shunt. The most important steps in our experimental studies in the ewe were creation of a fetal hydrocephalus by injection of a suspension of kaolin powder into cisterna magna; the treatment of the hydrocephalus by a mini-ventriculo-amniotic shunt, by cutting the cardiac end of a low pressure Pudenz pediatric catheter. Lambs were delivered by Cesarean two weeks before end of gestation. Coronal sections of brains of control and treated lambs showed reduction in hydrocephalus in the latter. These findings were the basis for the application of the method to treatment of human fetal hydrocephalus.

Solitary eosinophilic granuloma of cerebral lobes. Value of immunohistochemistry for a diagnostic interpretation.

Primary cerebral eosinophilic granuloma is a very rare lesion. In this study we report a further observation of solitary fronto-parietal eosinophilic granuloma in a child of three years. The immunohistochemical pattern, with the strong positivity of the histiocytic cells for PG-M1, an antibody which does not stain the Langerhans cells, suggests the reactive nature of the granulomatous lesion.

Intracranial pressure monitoring in children: comparison of external ventricular device with the fiberoptic system.

Several intracranial pressure monitoring devices have been developed in the past several years. We have recently adopted the Camino fiberoptic device that permits subdural, intraparenchymal, and intraventricular monitoring. In this report we compare experiences in monitoring a group of pediatric patients with severe craniocerebral trauma and coma, grouped according to severity of Glasgow Coma Scale score. Patient age ranged from 2 to 16 years. Twelve patients were monitored by a ventricular catheter and 37, treated more recently, by a Camino fiberoptic device. The study demonstrated that the fiberoptic device and the ventricular catheter have the same accuracy and reliability. The fiberoptic method correlates very closely with the ventriculostomy method, but the pressure values are always 3 +/- 2 mmHg lower than those obtained with the conventional pressure transducer system, especially in more critically ill patients. This new technique is also easier to implant, safer to use, has minimal drift, and is minimally invasive, which particularly speaks for its use in pediatric patients.

Outcome of craniocerebral trauma in infants and children.

The authors examined 927 patients affected by craniocerebral trauma and analyzed the neurological complications that occurred most frequently. The study confirmed that the percentage of craniocerebral trauma, gravity, and complications were different in relation to the sex and age of the patients. Based on this analysis, a correlation was made between the traumatic pathologies and socioeconomic-environmental conditions.

Computerized use of ICP data. Preliminary elements on the shunt patient.

An incorrect choice of valve may produce a delay in psychomotor development in shunted hydrocephalic children. The intracranial pressure was measured for 24 h in 20 subjects suffering from nontumoral hydrocephalus, obtaining a pressure/volume index with compliance and perfusion pressure data. Their data were entered into a computer and used to determine the correct valve to be chosen.

Familial dysautonomia in a non-Jewish girl, with histological evidence of progression in the sural nerve.

A case of typical familial dysautonomia (HSN, type III) in a non-Jewish girl is reported. The number of unmyelinated fibres was found to be reduced and sural nerve biopsy showed evidence of past axonal degeneration. There was also marked endoneurial fibrosis and a lack of the largest myelinated fibres. Signs of histological progression not yet described in the sural nerve and other clinical and morphological features could be explained by different penetrance degrees of the disease.

[Long-term surgical outcome and complications of treatment of non-neoplastic hydrocephalus in childhood. Considerations and our experience]. / Risultati operatori a distanza e complicanze nel trattamento dell'idrocefalia non neoplastica in età pediatrica. Considerazioni e nostre esperienze.

The AA., emphasized the surgical improvement in the treatment of non neoplastic hydrocephalus, relate their experience relative to last 16 years dwelling upon a surgical results at a distance and a founded complications too. After a discussion about the not solved problems in the treatment of this pathology, they conclude asserting that in addition to the shunt's application, it is absolutely necessary to verify, by means of post-surgical controls, that intracranial pressure is as much as possible near to the normality, to assure not only the patient's life but her quality too.

Experimental endo-uterine hydrocephalus in foetal sheep and surgical treatment by ventriculo-amniotic shunt.

After creating an experimental foetal hydrocephalus in sheep, we achieved its treatment utilizing the implantation of a ventriculo-amniotic shunt (mini-uni-shunt). The results obtained were satisfactory. However, it is evident that the application of an experimental technique in human foetuses requires maximum caution.

Xanthomatous posterior pyramid meningioma in a 2-year-old girl.

Meningiomas are common lesions in adults but unusual in infancy and meningiomas located in the posterior cranial fossa are even more rare. Metaplastic changes of meningothelial meningiomas can lead to the rarely observed xanthomatous form. We describe the case of a posterior pyramid xanthomatous meningioma in a 2-year-old girl. After detailed neuroradiological evaluation, the histological diagnosis was confirmed with the aid of immunohistochemical evaluation. A critical case evaluation in the light of the more recent literature, the surgical strategy and technique, and an immunohistological hypothesis are reported.

Spinal cord compression in homozygous beta-thalassemia intermedia.

Symptomatic spinal cord compression caused by an epidural mass of extramedullary hematopoietic tissue in patients with beta-thalassemia is a rare occurrence, that becomes exceptional in childhood and adolescence. The literature is not uniform about the optimal treatment of these patients and different modes of therapy have been proposed so far, including surgical excision or decompressing laminectomy followed by local irradiation and/or hypertransfusional regimens. We report the successful treatment of such a complication in an adolescent with homozygous beta-thalassemia by surgery followed by repeated blood transfusions aimed at maintaining hematocrit at normal levels.

Intraoperative monitoring of cerebral blood flow during ventricular shunting in hydrocephalic pediatric patients.

Several studies have demonstrated lowered cerebral blood flow (CBF) in patients with hydrocephalus and symptoms of raised intracranial pressure. Ventricular shunting in such cases permits a sudden increase in CBF. The pathophysiology of functional brain deficit secondary to hydrocephalus is little understood. Improvement of the patient's clinical status after drainage of CSF suggests that cerebral dysfunction is not necessarily due to permanent brain damage. In fact, it improves rapidly after ventricular taps. In view of this it would be helpful to monitor cerebral perfusion. The transcranial Doppler (TCD) ultrasonography technique allows real-time monitoring of the intracranial circulation and makes it possible to evaluate the physiopathological correlation between ventricular dilatation and CBF. Continuous monitoring of the middle cerebral artery (MCA) by TCD was performed in three hydrocephalic children (2 months, 14 months, and 8 years old) during a ventricular-peritoneal shunt operative procedure. A TC-2000S device provided by an IMP-F fixed probe was utilized. In all patients, when the lateral ventricle was shunted and the CSF could flow away, a clear and sudden increase of flow velocity above 30% was detected. The pulsatility index (PI) was also pathologically increased in all patients. A gradual normalization of this index was revealed after the shunting procedure. Our experience has to be considered preliminary, but nonetheless, it suggests a clear correlation between hydrocephalic disease and concomitant CBF alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

Turcot's syndrome: a new case in the first decade of life.

A case of Turcot's syndrome is described in an 8-year-old girl. Turcot's syndrome is a rare hereditary disease in which malignant glioma of the central nervous system is associated with colonic polyposis. The patient initially presented with a left parietal glioblastoma diagnosed by computed tomography (CT), and was subsequently found to have nonfamilial colonic polyposis.

Temporal osteoclastoma: an exceptional lesion in infancy.

Osteoclastoma is a rare skeletal lesion, characterized by large multinucleated giant osteoclastic cells; this lesion usually affects young adults with a prevalence of 1 case/1 million population. We report the case of a 9-year-old girl with a right temporal tumescence: X-ray, CT and MRI revealed the presence of a right temporal hyperostotic ring-like area over the lambdoid suture, with irregular margins and calcareous deposits. The tumour was expanding mainly toward the endocranium involving both cranial tables and diploë, without infiltrating the brain parenchyma. The child underwent complete microsurgical removal of the lesion. Histopathological findings revealed the giant cell tumour osteoclastoma. Correct modern preoperative neuroimaging workup, coupled with microneurosurgical technique, allowed successful lesion removal with good outcome. A review of the more recent literature and of mechanisms of pathology together with neuroradiological protocol and results of treatment are discussed.