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Biomedical subjects

S Cambria

Publications and source records attributed to S Cambria.

At least 19 recordsLinked to original sources

Venous saving in olfactory meningioma's surgery.

Bifrontal craniotomy and interhemispherical approach, usually used to remove olfactory groove meningioma, does not allow a view of posterior pole, which is very important in the surgical management of this neoplasm, and, provides for an anatomical sacrifice of frontal bridging veins, not without complications as a result of venous infarction. From 1975 the pterional approach was performed on 20 patients with olfactory meningioma, with good results in 90% of cases. This approach presents several advantages over bifrontal craniotomy and, in order to minimise surgical damage, it avoids planned sacrifice of venous vessels.

Adolescent↗

Basal meningiomas. A retrospective study of 139 surgical cases.

BACKGROUND: Basal meningiomas represent a significant group of intracranial tumours. Their surgical treatment presents still today several difficulties since these tumours, as it is well known, may involve critical neurovascular structures. METHODS: This is a retrospective study of 139 consecutive cases of basal meningioma operated on in our institution during the last two decades. Meningiomas location: olfactory groove 20 cases; suprasellar region 22; anterior cranial fossa 6; sphenoid wing 37; cerebellopontine angle/clivus 21; tentorium 26. In most cases the meningioma was larger than 5 cm. The tumour was completely removed (grade I-II of Simpson classification) in 111 cases (79.9%). The authors dwell upon some clinical and surgical aspects of prevailing groups (olfactory, suprasellar, sphenoidal, petroclival and tentorial meningiomas); regarding to operative procedures, the authors in particular emphasise the usefulness of the pterional approach to remove olfactory groove meningiomas and of the combined supra- and infratentorial approach, with preservation of transverse and sigmoid sinuses, to remove petroclival meningiomas. RESULTS: The surgery was followed by excellent or good results in 115 cases (82.7%): patients having a normal life with a score 80-100 of Karnofsky scale; poor outcome occurred in 5.8% of cases, postoperatively died 16 patients (mortality rate 11.5%). Tumour recurrence occurred in 7 cases. CONCLUSIONS: Based on their experience and on analysis of the reviewed literature, the authors conclude that advances in microsurgical techniques and in neuroradiological imaging have radically improved the outcome so that today basal meningiomas can be successfully treated in most cases.

Adolescent↗

Extradural haematoma. Report of 37 consecutive cases with survival.

The availability of CT scanning has considerably improved the results in patients with extradural haematoma (EDH). However, only few reports referred the "zero-mortality" which today could be considered as possible. This goal was achieved by us recently even in those patients suffering from rapidly developing EDH. A series of 37 consecutive patients with EDH operated on during the last years is presented. 27 patients were comatose GCS 3-8 on admission (within 6 hours after the injury) and underwent surgery immediately; in 7 cases the operation was performed 6 to 25 hours after the injury, soon after the worsening of the level of consciousness; 3 patients were awake at time of surgery and were operated on later than 24 hours after the injury when signs of neurological deterioration appeared. All of our patients survived and 35 of them (95%) fully recovered. We believe that the duration of brain compression is the main factor strongly correlated with outcome. Therefore, in our opinion the primary prerequisite in order to obtain a good result is the prompt evacuation of EDH; furthermore, in this was it is possible to try to prevent brain ischaemia due to clot pressure, mostly the infarction on deeply situated territories.

Adolescent↗

Symptomatic cysts of the pineal gland: stereotactic diagnosis and treatment of two cases and review of the literature.

We report two cases of pineal gland cysts, both in young girls, causing aqueductal stenosis and symptomatic hydrocephalus, which were diagnosed and treated by Talairach's stereotactic method. This procedure permitted aspiration of the cyst content, normalization of aqueductal stenosis, and a differential histological diagnosis. Postoperative computed tomographic scan examination showed a stable reduction of the cystic volume and a complete clearance of the hydrocephalus. At present, the two patients are clinically normal and are leading a productive life (follow-up, 42 and 40 mo). It is important that this kind of nonneoplastic lesion be identified, in order to avoid confusion with pineal tumors and possible inappropriate treatment. Pineal cysts rarely become symptomatic. Up to the present, only 27 symptomatic cases have been described in the literature. Of those, signs of intracystic bleeding were found in 17 of the 21 cases in which the cyst contents were known. Moreover, in our own two cases, numerous hemosiderin-laden macrophages were present in the cystic fluid. We think, therefore, that intracystic bleeding has been the determining factor for the occurrence of symptoms in most of these cases. The authors underline the advantages of this type of stereotactic management, which can provide both diagnosis and treatment and thus avoid the possible risks of surgical excision and/or of radiotherapy.

Adolescent↗

Computerized use of ICP data. Preliminary elements on the shunt patient.

An incorrect choice of valve may produce a delay in psychomotor development in shunted hydrocephalic children. The intracranial pressure was measured for 24 h in 20 subjects suffering from nontumoral hydrocephalus, obtaining a pressure/volume index with compliance and perfusion pressure data. Their data were entered into a computer and used to determine the correct valve to be chosen.

Cerebrospinal Fluid Shunts↗

[Experimental fetal hydrocephalus. Ventriculo-amniotic shunt].

When the original idea was conceived 8 years ago to develop a surgical technique for the treatment of fetal hydrocephalus, the pathway towards prenatal surgery for this affection was totally unexplored. The operation appeared to be feasible because of the possibility of a ventriculo-amniotic shunt. The most important steps in our experimental studies in the ewe were creation of a fetal hydrocephalus by injection of a suspension of kaolin powder into cisterna magna; the treatment of the hydrocephalus by a mini-ventriculo-amniotic shunt, by cutting the cardiac end of a low pressure Pudenz pediatric catheter. Lambs were delivered by Cesarean two weeks before end of gestation. Coronal sections of brains of control and treated lambs showed reduction in hydrocephalus in the latter. These findings were the basis for the application of the method to treatment of human fetal hydrocephalus.

Amnion↗

[Giant aneurysm of the sylvian artery in a 4-year old child (exeresis, remission)].

The AA. describe a case of a giant aneurysm 6 centimeters in diameter in a child of 4 years old. The lesion was made evident on the occasion of an hemorrhage that has caused an insular hematoma. The patient has undergone an operation with favourable outcome. The lack of neurologic symtomatology until the moment of the hemorrhage lead the AA. to think that this lesion was of the notables proportions from the moment of birth, so that the cerebral parenchyma was modeled on it. Unlike others cases in litterature recogniset, the wall of the aneurysmatic bag did not present fibrotics thickenings, and besides the blood-clot included in it seemed histologicaly of recent formation.

Cerebral Arteries↗