Biomedical subjects
Publications and source records attributed to A Raco.
Intramedullary glioblastomas are uncommon tumors. They occur chiefly in the cervicothoracic segments, have a slight tendency to occur in the early decades of life, and have a short clinical history before diagnosis. We report seven cases and discuss the salient features of these tumors, particularly the pathological features and treatment, in light of the relevant literature.
Actinomycosis is a bacterial infection that affects chiefly the cervico-oro-facial area, the abdomen and lungs. From these sites it may sometimes spread to the central nervous system. Extremely rare, and controversial, is the possibility of a primary infection of the central nervous system. We report an odd case of apparently primary brain abscess caused by Actinomyces israeli and review the literature.
Intradiploic epidermoid cysts, fairly uncommon lesions in neurosurgical practice, are, as a rule, benign and slow-growing. Some attain great size, producing major neurological signs. Correct radiological assessment and complete removal of the tumour and its capsule are essential for adequate surgical treatment and good long-term prognosis. We report ten cases of intradiploic epidermoid cysts of the skull, three of which were giant lesions and one malignant, and analyze the clinicopathological and radiological features and treatment of these lesions in the light of the most important published data.
Five new cases of vertebral hemangioma with cord compression are reported. The role of preoperative selective angiography with embolization in the management of these lesions is discussed in the light of the most important literature on this topic.
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Giant cell reparative granuloma is an infrequent nontumoral lesion affecting particularly the maxillary and mandibular bones and only rarely the cranial bones. The etiopathogenesis is still controversial and differential diagnosis, especially from giant cell tumors of bone, is arduous. We report a case of giant cell reparative granuloma of the middle cranial fossa which behaved like an intracranial tumor and which we followed up for 15 years. We discuss the relevant literature and describe the essential features of this controversial lesion.
We present 20 cases of primary intracranial lymphoma and review the most important published series on this subject. The clinical patterns and the differential diagnosis from other intracranial space-occupying lesions on the CT and angiographic evidence are discussed. Surgical treatment was given in 19 of our cases, followed in 17 cases by radiotherapy and in 4 by chemotherapy. One patient was treated by a ventriculo-peritoneal shunt. The effectiveness of the various modalities of treatment is discussed in the light of survival.
The authors present a series of 8 pure subependymomas of the central nervous system surgically treated between 1965 and 1987. The clinico-pathological features and the results of surgical treatment of these benign tumours are discussed in the light of the most important literature on this topic.
We report a case of primary cerebral lymphoma in an unusual site, the chiasma, and with a unique combination of symptoms. We review the salient published data on lymphomas in this site.
We report the results of surgical treatment in 13 patients operated on for compression of the spinal cord secondary to kyphosis or kyphoscoliosis between 1977 and 1985. In every case, an anterior decompression of the cord by transthoracic or thoracoabdominal route was followed in the same operation by anterior stabilization. Posterior fusion with Harrington's instrumentation was performed 15-20 days later. Neurological recovery was complete in 8 patients (61.5%) and partial in 4 (30.7%), while 1 patient died (7.6%). We review the relevant published work.
The 22 cases of spinal meningioma with severe motor deficit operated on during a 34-year span are reviewed. The motor deficit is graded according to a modified version of the scale proposed by Levy et al. in 1982, their grade IV being split into grade IV (toe movements and muscular concentrations) and grade V (paraplegia). All 10 grade IV patients were able to walk normally within a year of surgical treatment while only 50% of the grade V patients (12 cases) recovered, and then not completely. The preoperative duration of the motor deficit and age under 60 influenced the speed of recovery in the grade IV patients and the possibility of recovery in the grade V cases. We consider that the dual mechanism of mechanical and ischemic trauma played an important part in the speed and possibility of recovery in the patients reviewed.
Six patients under the age of 40 with fractures of the odontoid process (4 with Anderson type III and 2 with type II) were treated conservatively by immobilization in a halo device for 14-16 weeks. The indications for surgical and conservative treatment are discussed. Follow-up from 1 to 4 years.
We report a case of tethered cord syndrome treated surgically. As in many reported cases, the treatment was successful on pain but only partially so on sphincter dysfunction. The most important diagnostic investigation is CT scanning with contrast medium.
Description of a case of posterior cranial fossa meningioma without dural attachment, of which only 22 other cases have been published, is followed by a review of the relevant literature.
The authors report 9 cases of orbital schwannoma out of a total of 148 orbital tumors operated. The computed tomography (CT) scan is considered superior to other methods used in the radiological work-up of endoorbital tumors because, in addition to being noninvasive, it gives direct visualization of the lesion and more precise localization both with respect to the muscular cone and tridimensionally. Unfortunately, preoperative diagnosis is not always possible solely on the basis of the CT scan because the enhancement of the tumor is not constant, thus making differential diagnosis with meningioma and cavernous angioma problematic. In addition, CT enables the surgeon to choose the best route for tumor removal. Operative results are good and are influenced by the use of microsurgical techniques.
A report on the use of fibular graft in 15 cases of myelopathy secondary to cervical spondyloarthrosis with anterior compression of the dural sac at more than two levels. The surgical procedure is based on a midline somatotomy by anterior approach. The fibula appears to be more suitable for the purpose than the iliac crest due to homogeneity of structure throughout its length and to the mechanical strength afforded by its cortical ring.
The report of two cases of myxopapillary ependymoma of the sacral intradural portion of the filum terminale is followed by a discussion of the relevant literature.
Spontaneous cerebellar haemorrhage is very rare in children and is often associated with blood diseases such as haemophilia A or acute lymphatic leukaemia. During 1995, two paediatric patients with spontaneous cerebellar haemorrhage underwent surgical treatment in the Neurotraumatology Division of "La Sapienza" University hospital in Rome. The authors discuss this unusual pathology with particular regard to the age of the patients described.