Trigeminal neuralgia resulting from infarction of the root entry zone of the trigeminal nerve: case report.
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Diagnosis, Differential↗
Biomedical subjects
A Delitala
Publications and source records attributed to A Delitala.
Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated?
Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently "spontaneous", required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in "spontaneous" SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.
Arteriovenous Malformations↗
Life threatening intracranial complications of frontal sinus osteomas: report of two cases.
Paranasal sinuses osteomas are known as biological benign tumours. However, due to the peculiar anatomical relationships, patients harbouring an osteoma within the frontal sinus are exposed to serious orbital and intracranial complications. We report two unusual cases of intracranial mucocoeles associated with frontal osteomas. In one of them, a superposed tension aerocoele required emergency surgery. Although aggressive treatment of asymptomatic osteomas is not warranted, these lesions must be carefully observed and resected as soon as they show clinical and/or radiological signs of progression. The physiopathological and clinical aspects are discussed.
Bone Neoplasms↗
Surgical treatment of spasmodic torticollis: is there a role for microvascular decompression? With an illustrative case report.
Spasmodic torticollis (ST) is a puzzling movement disorder, characterized by involuntary tonic or clonic contractions of various neck muscles. From time to time, psychogenic, extrapyramidal and neuroperipheral origins have been postulated and reflecting the variety of theories proposed, as many different treatments have been attempted, none of which has shown absolute effectiveness. Surgery of ST classically includes destructive procedures such as myotomies, stereotactically placed lesions, rhizotomies and neurectomies. The recent application of the concept of "neurovascular conflict" to ST induced several authors to perform microvascular decompression (MVD) in these patients, with encouraging and in some cases long-lasting results. Our case report joins this group. From the analysis of pertinent literature we conclude that: a. Spasmodic torticollis is probably a collection of separate clinical entities; b. Even in the so-called "ST of neuroperipheral origin" some coexising central factor must be admitted; c. Neurovascular compression underlies at least some cases of ST. Historical, anatomical, physiopathological and clinical aspects of ST are extensively discussed.
Decompression, Surgical↗
Acromegaly and pituitary tumors: early anatomoclinical observations.
The elucidation of pituitary physiopathology has been a major challenge for physicians since early ages. Due to the unawareness of the endocrine system, acromegaly, the most striking pituitary disorder, was commonly regarded as an intrinsic bone disease. Andrea Verga and Vincenzo Brigidi, Italian authors of the 19th century, reported the first macroscopic and microscopic descriptions of pituitary adenomas in acromegalic patients. Although far from providing a correct pathogenetic interpretation of the disease, they opened the way to forthcoming observations and discoveries. A short history of acromegaly and pituitary physiopathology is drawn.
Acromegaly↗
Frontoethmoidal osteoma complicated by intracranial mucocele and hypertensive pneumocephalus: case report.
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Brain Diseases↗
Transoval administration of opiates into trigeminal cistern for cancer pain. Preliminary report.
A new method for administration of opiates into the ventriculo-cisternal system for intractable pain due to cancer is presented. Five patients suffering from such pain underwent the permanent implantation of a subcutaneous reservoir connected to a thin catheter inserted into the trigeminal cistern. The indications are those of the intraventricular way. Percutaneous trigeminal opiates administration (PTO) proved to be a valid and simple alternative method to intrathecal and intraventricular morphine.
Analgesia↗
Therapeutic approach to the Pancoast pain syndrome.
The incidence of the Pancoast syndrome ranges from 2 to 5% of patients with lung cancer. We treated 20 cases between 1979 and 1984 with 29 procedures including percutaneous cordotomy, selective posterior radiculotomy, decompressive laminectomy, central administration of opiates, and TENS. Selective posterior radiculotomy gave the best pain relief.
Buprenorphine↗
Therapeutic protocol in the treatment of trigeminal neuralgia.
The ideal treatment of trigeminal neuralgia is still an open question. A recent large series reporting the results from the three available percutaneous techniques has been reviewed. Fifty consecutive cases, treated from January 1984 to January 1985, are reported. Microcompression was performed as the first approach in all cases. The other techniques were adopted only in case of failure of microcompression.
Aged↗
Rupture of aneurysms during angiography. Report of two cases and review of the literature.
Two cases of rupture of intracranial aneurysms with contrast extravasation during angiography are reported. One was an aneurysm of the internal carotid bifurcation and the other a carotid posterior communicating aneurysm. The previously reported cases are analysed and the pathogenetic mechanisms thought to underlie the phenomenon discussed. The prognosis is anyway very poor.
Carotid Artery Diseases↗
Increase in size of cerebral angiomas. Case report.
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Cerebral Angiography↗
Intracranial arteriovenous malformations. Conservative and surgical treatment.
The authors present a consecutive series of 145 patients admitted to the Institute of Neurosurgery of Rome University with an intracranial arteriovenous malformation (AVM). Of these, 95 received surgical care, and 50 were treated conservatively. Total removal of the AVM was performed in all but three of the patients treated surgically, and all underwent postoperative angiography. The postoperative mortality was 6.3%. A long-term follow-up study showed a mortality rate of 20% in the group of patients receiving conservative treatment, while no recurrence of bleeding was observed in the surgical group. The choice of treatment of these malformations is still an open question. The authors' contribution to the discussion is based on the late results of both surgical and conservative treatment.
Adolescent↗
Hematoma of the quadrigeminal plate. Case report.
The authors report a case in which a hematoma of the quadrigeminal plate resulted from the rupture of a "cryptic" arteriovascular malformation (AVM) fed by the artery of the quadrigeminal plate. The AVM was symptomatic before rupturing and this clinical feature, associated with the lack of angiographic demonstration, led to the erroneous preoperative diagnosis of a tumor. In retrospect, the only finding that might have suggested the correct diagnosis was the beaded appearance on the ventriculogram of the aqueduct due to blood clots into this fluid space.
Adult↗
Recent experience in the management of meningeal hemangiopericytomas.
Although the histogenesis of meningeal hemangiopericytomas (HMP) remains controversial, both biological and clinical evidence seems to identify these neoplasms as a separate entity with respect to meningiomas. In order to assess the current prognosis of HMP we reviewed our personal experience limited to the last decade (1986-1995): during this period 7 patients (4M, 3F) were treated by surgery alone or surgery combined with postoperative radiotherapy. In spite of meticulous attempts at radical resection, the tumors recurred in all but two cases with a mean interval of 85 months, and a total of 18 operations were performed (2.57/patient; range 1-4). Massive intratumoral hemorrhage determined acute deterioration and required emergency surgery in two cases while in one patient diffuse visceral metastases were discovered at autopsy. Five patients are still alive at follow-up but only 2 of them are in good neurological conditions and without evidence of disease. These results are similar to those reported in other series. In view of our results we conclude that intracranial hemangiopericytomas still have a dismal prognosis. Advances in neuroimaging, neuroanesthesia, microneurosurgery and adjuvant therapy do not seem to have significantly affected the recurrence rate, quality of life and mortality.
Adult↗
[Encephaloceles. with special reference to the diagnostic difficulties].
We have studied 15 occipital, 3 frontal and one parietal cases of encephaloceles from the point of view of the etiopathogenetic, clinic and especially diagnostic problem. The diagnosis of M.E. is based on: 1) the x-ray demonstration of the bone-gap by particular projections and by tomography; 2) in the frontal M.E. the presence of face deformity, with hipertelorism and widening of nose bridge and the finding of ectopic tissue in the nose or in the oral cavity in presence of palatoschisis. Cerebral angiography and pneumoencephalography, made by tomography, are useful to show the herniated brain, hydrocephalus and other associated anomalies. Finally we think computerized tomography (C.T.) is very important for the diagnosis, since it shows the herniation, the bone-gap and the kind of herniated tissue.
Abnormalities, Multiple↗
Microsurgical DREZ-lesion in the treatment of deafferentation pain.
The lesion of the dorsal root entry zone (DREZL) of the spinal cord, recently introduced by Nashold and performed with radiofrequency or with laser, may be carried out with a microsurgical technique. Since 1978 up 1982 we have treated a series of 12 patients suffering from Pancoast's syndrome with a C8-T2 selective posterior rhizotomy (SPR). It has been observed that every deafferentative aspect of the pain was completely relieved. Such effect on the deafferentative aspect of the pain was most probably due to a lesion on the perforating vessels feeding the posterior grey horn. The lesion of this structure was therefore ischemic and this operation had to be indicate for the treatment of such pain. A series of 8 patients, suffering from cancer pain projected to anaesthetic areas, and 2 patients with benign post-thoracotomy pain, underwent to microsurgical DREZ lesion. The relief from pain was complete and no complications concerning pyramidal or posterior pathways involvement was observed. Preliminary good results suggest that a more selective lesion is possible with the microsurgical DREZ. It should be interesting a comparison between more large series of microsurgical DREZL and the more tested radiofrequency lesion.
Adult↗