Biomedical subjects
Publications and source records attributed to F A Cioffi.
Diagnostic work-up and management of intracranial arachnoid cysts are still controversial. The authors have standardized a therapeutic protocol based on the information derived from CSF contrast flow studies. The report concerns 16 cases of intracranial arachnoid cysts treated according to their protocol.
The authors report 3 cases of subdural tension pneumocephalus developed after surgery for subdural chronic hematomas. The mechanisms involved in the pathogenesis of this complication are discussed; the importance of the computed tomography in the assessment of the subdural tension pneumocephalus is stressed. Surgery is always indicated in cases of increased tension of the air collection and generally resolves the neurological deficits.
The authors report our experience on 19 cases of discitis developed after operations for herniated lumbar disc. Because of the negativity of the neuroradiological studies in the acute stage, the recognition of the typical syndrome (severe back pain, spasm of the paravertebral lumbar muscles, limited spinal motility, fever) beginning 3-30 days post-operatively and the study of some laboratory tests (elevated Erythrocyte sedimentation rate (ESR) and midly to moderately elevated white blood cells (WBC) are very important for diagnosis. The first radiographic findings (disc space narrowing, ecc.) are detectable only 4 to 6 weeks after the first symptoms; other X-ray findings are not seen post-operatively before 6 months-2 years. The CT-scan is diagnostic of discitis only when the following three specific signs are present: a) anterior paravertebral soft tissue swelling with obliteration of paravertebral fat planes; b) fragmentation or erosion of vertebral end plates; c) paravertebral fluid collection (abscess). In our experience a period of immobilization of the spine with a plaster body jackets and the use of adequate antibiotic therapy are the more effective treatment. Undoubtedly the discits are the results of an infection that must be prevented adhering to the aseptic principles not only during surgery but also during the procedures performed in the radiology suite.
Giant intracranial aneurysms containing a tortuous vascular channel appear, to some extent, different from other giant aneurysms. Their particular features are outlined in the present report which concerns a case of a small fusiform aneurysm of the posterior temporal branch of the middle cerebral artery evolving over five years into a giant serpentine aneurysm. Successful and complete removal of this lesion was achieved.
A case of fibromuscular dysplasia (FMD), mostly involving the basilar artery, associated with an intracranial aneurysm, is presented. Although the patient was symptomatic, the typical angiographic pattern is felt to be in this case an incidental finding. However the potential for FMD to produce severe neurological impairment is emphasized. The case is used as a basis for discussing shortly the incidence, the characteristic radiological appearance, the relationship with the presence of intracranial aneurysms and the therapeutic problems of FMD.
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The incidence of kinking and coiling of the internal carotid artery in an unselected series of 1,010 angiographies is reported. The angiographies of patients with cerebrovascular insufficiency and those of patients with other brain diseases were separately reviewed. On the basis of a statistical comparison, the finding of kinks and coils appears significantly higher in "vascular" than in "non-vascular" patients. The greater difference concerns age subgroups up to 50 years. These data give support to the assumption that both kinking and coiling of the internal carotid artery may play a role in determining cerebral ischemic attacks. Surgical experience concerns a series of 19 patients operated by various corrective procedures, including resection of the internal carotid artery and end-to-end anastomosis. It is felt that surgery, performed in appropriately selected cases, can afford significant benefits to cerebrovascular patients, especially those presenting recurrent ischemic episodes.
Four main models of vascular microsurgical anastomoses in rabbits are described with reference to revascularization procedures in man. Some technical expedients designed to improve the patency rate, are outlined. This preliminary report emphasizes the value of laboratory training to achieve successful results with microneurosurgical treatment of cerebral ischemia.
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12 cases of cerebral "venous angioma" are reported; pathological, clinical and radiological features of the lesion are reviewed. "Venous angioma" should be regarded as a developmental anatomic variation of the venous drainage system of the white matter. Its clinical significance is controversial, although it has been reported to cause hemorrhage, seizures, progressive neurological deficits, headaches. The clinical presentation of our patients was variable and, in some of them, dependent also on associated lesions. An hematoma was found in three patients, infarction in one and tumor in one. Angiography, CT and MRI demonstrated the typical appearance of the anomaly. Surgery was performed in one patient harboring a significant cerebellar hematoma and the coexistence of a cavernoma was pathologically confirmed. Venous developmental anomalies are often identified as the source of symptoms due to other conditions, that should be treated independently sparing the anomaly.
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