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Biomedical subjects

M D Cusimano

Publications and source records attributed to M D Cusimano.

At least 37 records · Page 2Linked to original sources
PubMed1997

Schwannoma of the cauda equina.

OBJECTIVE: To review the features of spinal schwannoma in a case that mimicked a lumbar disc herniation. CLINICAL FEATURES: A 37-yr-old woman suffered from a 4-yr history of progressive low back and leg pain, with progressive neurological involvement of several nerve roots. Noteworthy symptomatology included increased pain when lying recumbent and urinary and fecal incontinence. Several health care practitioners diagnosed her with a lumbar disc herniation. Investigations with myelography, computed tomography (CT) with myelographic contrast and magnetic resonance imaging (MRI) revealed the presence of an intradural tumor at the T12-L2 region. INTERVENTION AND OUTCOME: The tumor was surgically resected via laminectomies at T12-L2. The patient experienced a decrease of pain intensity but continued to complain about the low back and posterior thigh pain and has been unable to return to work. She continues to suffer from urinary incontinence, which is controlled by medication. There has been no recurrence of the tumor. CONCLUSION: Spinal pathology such as schwannoma of the cauda equina can mimic common complaints of low back pain seen in clinical practice. Differentiating features of cauda equina tumors from lumbar disc prolapse include: pain on lying recumbent, progressive nature of the pain and neurological deficit, involvement of several nerve root levels and intractability of the condition to conservative therapy. The most appropriate methods for imaging these tumors are CT with myelography or MRI. Patient prognosis is improved with early detection and removal. Chiropractors can play a pivotal role in the care of these patients by being suspicious of patients who do not respond as expected to a course of manipulative therapy, by investigating or referring appropriately and by aiding in active rehabilitation postoperatively.

Adult↗
PubMed1996

The technique for endoscopic pituitary tumor removal.

A number of milestones have marked the development of transsphenoidal pituitary tumor resection this century. The introduction of headlamp illumination, followed by the use of the operating microscope and fluoroscopy have allowed neurosurgeons to perform this surgery in a safe and highly effective manner. With the aid of a case report, we describe the incorporation of endoscopic techniques in pituitary tumor resection. The technique described is minimally invasive, avoiding septal dissection and allowing unsurpassed, unobstructed, and panoramic visualization of the region of interest to the surgeon and operative team.

Journal Article↗
PubMed1996

The spectrum of cavernous sinus and orbital venous thrombosis: a case and a review.

Orbital venous pathologies encompass a broad range of entities including tumors, shunts, congenital anomalies, aneurysms, and obstructive lesions. Patients may present with a variety of clinical findings which may include a combination of tumefaction, vascular engorgement, orbital pulsation, and exophthalmos, depending on the relationship between the lesion and the vascular system. Clinical findings may be unreliable in excluding serious underlying disorders, and so an extensive clinical and radiologic evaluation is necessary. This article presents a rare case of spontaneous aseptic cavernous sinus-superior ophthalmic vein thrombosis in a woman on hormone replacement therapy, and illustrates the multidisciplinary approach in diagnosis and management. The literature on issues surrounding this case is reviewed.

Case Reports↗
PubMed1995

Vertebral artery injury associated with a Jefferson fracture.

BACKGROUND: The evaluation and treatment of Jefferson fractures, a burst fracture of the ring of Cl, has been well documented in the medical literature. Vertebral artery injury associated with a Jefferson fracture is very rare. METHODS: The case study technique was used to summarize the case. Review of the literature was performed to discuss the case. Retrospective chart review of the 174 patients with cervical fractures admitted to St. Michael's Hospital from 1989-1994 was also performed. RESULTS: The case of a patient with a Jefferson fracture, with bilateral lateral displacement of the lateral masses causing bilateral vertebral artery occlusions resulting in a lateral medullary and cerebellar infarction is reported. A review of the literature is provided. CONCLUSION: A high index of suspicion for this injury is paramount, especially in patients with multiple trauma, where the diagnosis of Jefferson fractures can be delayed.

Adult↗
PubMed1995

The results of surgery for benign tumors of the cavernous sinus.

CAVERNOUS SINUS SURGERY has been performed increasingly in the last 2 decades because of new knowledge and technologies. With increasing international expertise in cavernous sinus surgery, the results must be analyzed critically to search for accurate prognosticators of outcome. We performed a retrospective review of 124 patients (40 male, 84 female; mean age, 45 years) who underwent cavernous sinus surgery for benign tumors from 1983 to 1992. Sixty-five percent had tumors encasing the internal carotid artery. Mean follow-up was 29 months (median, 26 mo). Gross total or near-total resection was possible in 80%. Patients with neurilemomas, angiofibromas, epidermoids, chondroblastomas, and hemangiomas were more likely to have total or near-total resection (100% versus 75%, P < 0.025). Disabling complications (five cerebral infarctions, two meningitis, and one hydrocephalus with chiasmal prolapse) occurred only in patients with meningiomas or pituitary adenomas. On follow-up, excellent/good binocular vision was achieved in 53% of patients entering surgery with excellent/good function versus 25% who entered surgery with fair/poor binocular vision (P < 0.025). Ninety-three percent of patients had a Karnofsky score > or = 70 on follow-up. There were a total of 12 recurrences (10%), 6 in patients with meningiomas, 2 in patients with angiofibromas, 2 in patients with craniopharyngiomas, 1 in a patient with a pituitary adenoma, and 1 in a patient with an osteoblastoma. Patients with tumor growth or neurological symptoms indicative of progressive cavernous sinus involvement should undergo cavernous sinus exploration. This surgery has acceptable morbidity and mortality and, if the tumor can be removed easily, the surgeon should try to perform radical tumor resection. To avoid major complications, the surgeon must exercise utmost care to preserve the neurovascular structures of the cavernous sinus, with special attention to tumors that extend into the petroclival region. Better results from surgery can be expected in those patients with neurilemomas, hemangiomas, or epidermoids than in patients with meningiomas, craniopharyngiomas, or pituitary adenomas. Good functional outcome can be expected, particularly if the patient's preoperative clinical status is good. Particular attention must be paid to the reconstruction of anatomic barriers in order to prevent cerebrospinal fluid leakage and subsequent meningitis.

Adult↗
PubMed1995

Extreme lateral disc herniation manifesting as nerve sheath tumor. Case report.

This report discusses the clinical features of a patient who presented with an L-3 radiculopathy in whom magnetic resonance imaging demonstrated what appeared to be a nerve sheath tumor in an extraforaminal location on the L-3 nerve root. A lateral intermuscular approach to excise the lesion was used to preserve the facet joint. Histological examination of the intraneural lesion revealed degenerative disc fragments. The authors hypothesize that the structure of the annulus fibrosus in the upper lumbar region predisposes these regions to lateral herniation. Furthermore, it is proposed that the lateral disc herniation allowed the disc fragments to erode through the epineurium of the neural sheath. This case expands the differential diagnosis of fusiform enlargement of nerves to include disc herniation.

Adult↗
PubMed1994

Aspergillosis of the cranial base.

Aspergillus is an ubiquitous organism seldom pathogenic in normal hosts. Aspergillus osteomyelitis of the spine occurs rarely in immunocompromised patients as a result of hematogenous spread from distant foci. We present a case of Aspergillus osteomyelitis in the region of the jugular foramen in a previously healthy male with no antecedent event. He presented with dysphagia, hypophonia, and weight loss of several months duration. Diagnosis was delayed due to nonspecific results of various imaging tests. We review the clinical course of fungal osteomyelitis, including appearance on magnetic resonance imaging and computed tomography, culture characteristics, and gross appearance. Current treatment consists of surgical debridement and antifungal medications such as amphotericin B and itraconazole, and the efficacy of these are discussed.

Case Reports↗
PubMed1994

Pituitary carcinoma.

The presence of distant metastases may be asymptomatic in patients who present with symptoms and signs due to the local mass effects of an invasive pituitary adenoma. A case of pituitary carcinoma in a 54-year-old man who presented with widespread asymptomatic distant metastases 12 years after initial diagnosis is reviewed. The long course and asymptomatic metastases suggested a relatively slow-growing malignancy. The factors that played a role in the pathogenesis of the metastasis are unknown. A review of the literature on pituitary carcinoma suggests that accurate diagnosis and a multidisciplinary approach to management of such lesions emphasizing surgery, radiotherapy, and hormonal manipulation may provide these patients with the longest and best quality of survival.

Journal Article↗
PubMed1994

A comparative analysis of the costs of administration of an OSCE (objective structured clinical examination).

BACKGROUND: The objective structured clinical examination (OSCE) has become an accepted technique for the evaluation of clinical competence in medicine. Although advances have been made in our knowledge of the psychometric aspects of the OSCE, extremely little has been written about feasibility and cost issues. Given the current economic imperative to control costs and the extremely scant literature on the costs of developing and administering an examination in medicine, the authors felt it timely and relevant to explore issues related to the cost of the OSCE. METHOD: In 1991-92 and in 1992-93, costs and time requirements to implement and administer a structured oral (SO) examination and a six-station OSCE for a surgical clerkship at the University of Toronto Faculty of Medicine were gathered by review of invoices, interviews with those involved, and perusal of diaries kept by staff. RESULTS: To develop and administer the six-station OSCE, 327.5 hours of staff and faculty time were required for each rotation of surgical clerks (8.2 hours per student). The SO examination required 110 hours of staff and faculty time (2.75 hours per student). Direct expenses for the OSCE amounted to U.S. $6.90 per student per station, compared with no direct expense for the SO examination. CONCLUSION: The OSCE was more time-consuming and more expensive in human and material costs than the SO examination. However, costs of the OSCE can be substantially reduced from approximately U.S. $35 to U.S. ! per student per station if test developers, standardized patients, support staff, and examiners can donate their time. The authors compare the costs and time requirements of their OSCE with those of other OSCEs reported in the literature, and they provide guidelines to assist educators in deciding whether the costs of an OSCE are justifiable in the educators' individual settings.

Clinical Clerkship↗
PubMed1994

Partial hypoglossal to facial nerve anastomosis for reinnervation of the paralyzed face in patients with lower cranial nerve palsies: technical note.

Reanimation of the paralyzed face in patients who have coexisting lower cranial nerve palsies is a difficult management problem. Classic hypoglossal to facial nerve anastomosis may be devastating in these already compromised patients. We describe a technique of partial hypoglossal to facial anastomosis that can preserve hypoglossal nerve function and provide adequate facial reanimation.

Adult↗
PubMed1994

Pseudo-cerebrospinal fluid rhinorrhea.

Because of its potentially serious sequelae, cerebrospinal fluid (CSF) leakage following surgery for lesions of the cranial base is given immediate attention by neurosurgeons. Despite a multitude of approaches used to prevent its occurrence, CSF leakage complicates up to 30% of difficult skull-base tumor operations. The authors describe the cases of 11 patients who developed a syndrome, not previously described in the literature, termed "pseudo-CSF rhinorrhea." This syndrome occurs after surgery of the cranial base, usually involving dissection or removal of the petrous or cavernous carotid artery, the greater superficial petrosal nerve, and the pericarotid sympathetic plexus. It is characterized by nasal stuffiness and nasal hypersecretion and is sometimes accompanied by facial flushing. The symptoms are characteristically exacerbated by exertion or by elevated ambient room temperatures. Lacrimation is typically absent ipsilateral to the pseudo-CSF rhinorrhea. It is believed that pseudo-CSF rhinorrhea developed in these patients because of a relative imbalance of the regulatory autonomic supply of the nasal mucosa.

Adult↗
PubMed1992

Arteriovenous malformation of the pyriformis muscle manifesting as a sciatic nerve tumor.

We present a patient with an intramuscular pelvic arteriovenous malformation that was initially diagnosed as a tumor of the sciatic nerve sheath. Endovascular embolization, attempted as a preoperative maneuver, was complicated by diffuse pulmonary emboli and death. To our knowledge, this is the first such reported case. Its presentation here broadens the differential diagnosis of sciatic nerve sheath tumors, emphasizes the diagnostic and management issues of masses presenting as peripheral nerve tumors, and provides clinicopathological evidence regarding the cause of neurological symptoms.

Angiography↗