Biomedical subjects
Publications and source records attributed to M Poza.
The case of a neonate with a dermoid cyst originating within an occipital encephalocele is reported. The finding of the tumor was made during the routine repair of the meningoencephalocele. To our knowledge this is the first time that this association has been described.
Complications of valve reservoirs or flushing devices are seldom reported as a cause of shunt malfunction. The authors document their experience in six cases of mechanical complications of shunting devices. Two cases presented with collapse and intracranial migration of the valve reservoir, a complication that has not been reported previously. In two cases, the plastic dome became disconnected from the metallic base of the reservoir. A fifth patient, with an integral shunt system, showed a fracture in the soldered join of the distal tube to the reservoir dome. The last patient had the valve reservoir partially collapsed by bone growth at the time of shunt revision.
Atretic cephalocele appears as an unimportant and benign lesion. This malformation consists of meningeal and vestigial tissues (arachnoid, glial, or central nervous system rests). The authors report the findings in 16 cases (seven parietal and nine occipital) of rudimentary cephaloceles. Twelve patients presented with associated brain abnormalities detected by either computerized tomography (CT) or magnetic resonance imaging (MR). Nine lesions also exhibited an anomalous vascular component demonstrated by CT or MR imaging or at surgery. The existence of this tiny malformation in five cases was the main diagnostic clue to a severe complex of cerebral anomalies, namely cerebro-oculomuscular (Walker-Warburg) syndrome. An occipital location of the atretic cephalocele was associated with the worst prognosis, with only two children developing normally. However, a parietal location carried a better prognosis, which is contrary to the outcome reported in the current literature. The authors classify atretic cephaloceles into two types based on histological examination of the surgical specimens, and suggest that these types represent different stages in the development of this malformation. It is concluded that, in the evaluation of the atretic cephalocele, the neurosurgeon is obliged to proceed to a detailed neuroradiological study of the patient and that the prognosis does not depend on the existence of the cephalocele itself, but rather on associated "occult" brain anomalies.
BACKGROUND: Analysis of the epidemiologic characteristics of cerebral abscesses and comparison with 2 therapeutic schedules. METHODS: The clinical history of 66 patients with cerebral abscesses admitted over 14 years in the Neurosurgical Ward of the Virgen de la Arrixaca Hospital in Murcia were reviewed. Two therapeutic groups were designed of 33 and 31 patients respectively treated with classical or modern schedules and clinical efficacy was evaluated. RESULTS: Infections in the ORL area, craneoencephalic trauma, and brain surgery were the predisposing factors in 63% of the cases. The most frequent symptoms were migraine, fever, and alteration of consciousness in 75, 68 and 68% respectively. The most frequent locations were the temporal (36%), parietal (26%) and frontal lobes (23%). Microbiological studies were positive in 75% of the patients with the most frequent microorganisms being group A Streptococcus, Proteus mirabilis, Staphylococcus aureus and anaerobes. Mortality was 14%. Twenty-two percent of the patients had neurological sequelae. The rate of mortality was significantly associated to age greater than 40 years, fatal underlying disease, coma, initial clinical criteria and inadequate antibiotic treatment. The combination of cephotaxime-metronidazole was significantly associated to greater cure in comparison with the classical antibiotic combination although no significant differences were found in either the rate of mortality or relapse. CONCLUSIONS: The combination of cephotaxime-metronidazole may constitute an interesting advance in the treatment of these processes. The epidemiological data obtained confirm those of larger series.
Nine pediatric cases of solitary eosinophilic granuloma (EG) are reported. Six children harbored cranial lesions and three had spinal involvement. Plain radiographs and computed tomography scan were not always sufficient for diagnosis. Isotopic bone scan was useful to rule out multiple lesions. The authors' opinion is that surgical excision is the treatment of choice for cranial lesions, leaving radiotherapy for possible relapse. Management of EG of the spine should start with needle biopsy, followed by radiation therapy, surgery being indicated in selected patients with immediate risk of neural compression. Mean follow-up time was 4.4 years (longer than several reported series). At the time of revision all children were asymptomatic, and only one case presented a local recurrence that was managed by radiotherapy.
Overdrainage of cerebrospinal fluid (CSF) is a well-known complication of shunting procedures. Several clinical manifestations of excessive drainage of CSF have been documented, such as subdural hematoma, subdural effusions, slit ventricles, isolated IV ventricle, etc. To the authors' knowledge, this is the first report of an arachnoid cyst due to the excessive function of a VP shunt.
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Classically meningiomas present and evolve with a progressive course. Meningiomas manifest themselves mainly in middle and old age when the incidence of strokes is higher. The authors report three instances of meningioma with acute haemorrhagic onset. The clinical picture of our cases consisted of subarachnoid bleeding, subdural hematoma and intracerebral haemorrhage respectively. The diagnostic difficulties encountered when assessing these patients are discussed. The current literature regarding meningioma associated with haemorrhage is reviewed. One of our cases seems to be the first reported case of subarachnoid haemorrhage originating from a meningioma of the petrous bone.
The authors report the case of a 9-year-old girl with a low-grade astrocytoma of the mesencephalon that occluded the sylvian aqueduct. Symptoms, signs, and neuroradiological investigations led to the clinical impression of aqueductal stenosis. The presence of a tumor was diagnosed by cerebrospinal fluid cytology and confirmed at postmortem examination. This is the first reported instance of this tumor being diagnosed by cerebrospinal fluid cytology and the third report of a diagnosis in a living patient. The authors stress the value of CSF cytology in evaluating a typical case of hydrocephalus.
The case of a 4-year-old girl who developed bilateral brain abscesses complicating skull traction is reported. Crutchfield tongs were used to reduce a fracture dislocation at C2-3. Presenting symptoms consisted of headaches and focal seizures. Surgical treatment and antibiotics using serial CT led to a satisfactory outcome. This is the first reported case of this complication in a child. The current literature is reviewed.
The authors report a case of a ventricular oligodendroglioma associated with a cortical arteriovenous malformation. The patient presented with subarachnoid hemorrhage. Computed tomographic scan showed an intraventricular hyperdense lesion, mimicking a hematoma. Angiography revealed a superficial arteriovenous malformation in the right parietal lobe, unrelated to ventricular cavities. Both lesions were treated during the same operation. The diagnostic difficulties and the significance of this uncommon association are discussed.
Epidermoid cysts over the anterior fontanelle were once regarded as rare and exclusive to blacks. The latest reports in the literature indicate a more widespread incidence. Only a few cases have been described in Europe. The authors report three cases of epidermoid cysts in this location occurring in Spaniards. Clinical, radiological, and surgical features are briefly discussed and pertinent literature is reviewed.
A modification of Gildenberg's technique for brain tumor biopsy is described. Marking the light beam of the gantry on the scalp with a pencil, when the lesion appears on the screen, no ScoutView is necessary. With radiopaque marks on the drawn lines, the levels of the slice are transferred to a lateral conventional X-ray, for calculation of the 'Z' coordinate. 'X' and 'Y' coordinates are determined on the CT scanner.
The case of a 5-month-old boy with sagittal synostosis secondary to a calcified cephalohematoma of the cranial vault is reported. Although birth trauma has been suggested as a cause of craniosynostosis, a review of the current literature failed to show a similar case. Surgical treatment to remove the calcified hematoma produced good cosmetic and functional results.
The authors report the case of an infant who presented with an epidermoid tumor contained in a lumbosacral myelomeningocele. The association of spina bifida aperta and congenital intraspinal tumors is rare. Only two cases of teratoma and two cases of epidermoid tumors arising within a meningocele have been documented previously.
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