Clinical clerkships in neurosurgery and neurology at United States medical schools.
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Clinical Clerkship↗
Biomedical subjects
S Constantini
Publications and source records attributed to S Constantini.
Severe limitation in mouth opening following transtemporal neurosurgical procedures: diagnosis, treatment, and prevention.
Five new patients and six previously described patients with severe limitation in maximum mouth opening following transtemporal neurosurgical procedures are described. Six patients underwent an operation for epidural hematoma and three for skull-base meningloma; two were treated with a pterional craniotomy for an aneurysm. Limited maximum mouth opening in these circumstances is caused by temporal muscle scarring and shortening. Aggressive physiotherapy is potentially beneficial if started early. If, however, diagnosis is delayed, the efficacy of physiotherapy declines, and surgical treatments such as temporal muscle detachment and coronoidectomy are fully indicated. The differential diagnosis, prevention, and treatment of limited maximum mouth opening following neurosurgical procedures are discussed.
Adult↗
[CT-stereotactic determination of targets for thalamotomy for movement disorders].
The methodology of determining an invisible target by CT-stereotaxy, such as the ventrolateral nucleus of the thalamus, is described. This approach obviates the need for traditional ventriculographic determination of the third ventricle commissures and allows accurate measurement of third ventricular width. Morbidity and length of hospitalization are thereby reduced.
Adolescent↗
Familial intracranial arachnoid cysts.
Three siblings with intracranial arachnoid cysts are described, two males and one female. One of the males has symmetric, bilateral, temporoparietal convexity cysts, and the others have singular, unilateral cysts. Three additional siblings in the family and other known relatives are clinically unaffected. As far as we know, this is the second reported case of familial intracranial arachnoid cysts and the first involving three siblings. The significance of these cysts and a review of the literature are presented.
Arachnoid Cysts↗
Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumors.
A retrospective study was designed to evaluate clinical thromboembolic phenomena (TEP) in patients operated upon for brain tumours. Among 492 patients treated surgically in the supratentorial area, the overall incidence of clinical TEP was 7%. There were 5% with deep vein thrombosis (DVT) and 4% with clinical pulmonary embolism (PE). Seven patients (1%) died from massive PE. Among 141 patients treated surgically in the infratentorial area there were no episodes of TEP. Significant risk factors for TEP development were operations in the supratentorial area, malignant gliomas (compared to meningiomas) and para- or hemiparesis. Age, sex and the specific location in the supratentorial area were not found to be statistically significant risk factors. Among 12 patients who presented initially with DVT two developed PE despite full heparinization. 7/19 patients with PE died within minutes to hours of the clinical episode despite full conservative measures. In 2/26 patients who were treated with full heparinization complications occurred. There was one case of diffuse subcutaneous bleeding and one case of tumour bed haematoma. The identification of risk factors for the development of TEP will allow the implementation of prophylactic measures in appropriate patients undergoing elective brain tumour surgery.
Adult↗
The use of fibrin sealant in cerebrospinal fluid leakage.
Cerebrospinal fluid leakage is one of the central problems facing neurosurgeons, both due to its occasional difficulty in management and to the catastrophical significance of ensuing infection. An important tool emerging in the surgical management of CSF leakage is fibrin sealant, the natural coagulation product. Thirteen cases of CSF leakage, due to meningomyelocele, posttraumatic, and secondary to tumor, that were managed surgically with fibrin sealant are presented. Several of the cases were successfully operated upon following failure of conventional surgical techniques. Additional uses of fibrin sealant in neurosurgery are discussed.
Adenoma↗
Hypertrophic spinal pachymeningitis: report of two cases and review of the literature.
The cases of two patients with idiopathic pachymeningitis hypertrophica that caused progressive paraparesis are presented. Gadolinium-enhanced magnetic resonance imaging was used to demonstrate this pathological entity in one patient, and myelography was used in the other. Decompressive surgery led to significant neurological improvement. The etiology, diagnosis, and management of this disease is discussed, and the literature is reviewed. To our knowledge, this is the first report to describe the features of this rare pathological entity on magnetic resonance imaging.
Aged↗
Evaluation of an enzyme membrane immunoassay (Directigen RSV) for the rapid diagnosis of respiratory syncytial virus infections.
A rapid enzyme immunoassay (EIA) membrane test, the Directigen respiratory syncytial virus (Becton Dickinson), was compared with cell culture, an indirect immunofluorescence (IF) test, the Monofluokit respiratory syncytial virus (Diagnostics Pasteur), and a conventional enzyme immunoassay antigen test, the Abbott respiratory syncytial virus enzyme immunoassay in nasal aspirates specimens from children with suspected respiratory syncytial virus (RSV) bronchiolitis. The sensibility and specificity of the Directigen, respiratory syncytial virus were 91% and 98% respectively, as compared with those of culture, and of 93% and 86% as compared with the Monofluokit respiratory syncytial virus. In the comparison of the two enzyme immunoassays, Directigen respiratory syncytial virus detected more positive specimens: 68/127 than the other: 46/127. Directigen respiratory syncytial virus is a very rapid test, (15-min), sensitive and specific, which can be used as an alternative technique for detection of respiratory syncytial virus in nasal samples when viral isolation or immunofluorescence direct are not available.
Cells, Cultured↗
[Surgery for craniopharyngioma].
We present a series of 20 patients (11 males) operated on for craniopharyngioma through a frontal craniotomy during an 11-year period. They ranged in age from 7 months to 58 years (mean 20 years). The most common symptoms were headaches, blurred vision and endocrine disorders. The perioperative mortality was 5% and morbidity 25%. 5 (25%) patients need reoperation; 13 (65%) received additional radiation therapy. In 94% visual function improved. 65% continued to have or developed endocrine problems, although all were well controlled with supplemental therapy. These results, similar to those reported from other centers, justify a combination of radical surgery and radiation therapy for this condition.
Adolescent↗
[Interstitial radiotherapy for brain tumors].
Interstitial radiotherapy (brachytherapy) for brain tumors has radiobiological advantages over conventional teletherapy. With this method the tumor area can be exposed to effective, high dose irradiation with minimal damage to surrounding tissues.
Brachytherapy↗
Nuclear magnetic resonance and lipids of the plasma from patients with intracranial tumours.
The plasma of fifteen patients with malignant primary intracranial central nervous system (CNS) neoplasms was examined using proton nuclear magnetic resonance (NMR) and lipid level analysis. Twenty-three benign intracranial neoplasms and twelve non-CNS, non-malignancy patients served as control. At 300 MHz the NMR mean line width of plasma with malignant tumours was (+/- 2 SE) 37.2 +/- 3.0 Hz and for benign tumours 33.5 +/- 3.0 Hz (P = 0.09). The mean plasma triglyceride level for the malignancy patients was 100 +/- 25 mg/decilitre and 173 +/- 74 mg/decilitre for the patients with benign tumours (P = 0.07). The mean plasma cholesterol was 182 +/- 42 mg/decilitre for the malignancy patients and for the patients with benign tumours 241 +/- 29 mg/decilitre (P = 0.03). Unfortunately overlaps of the values of the different groups, in spite of statistically significant differences, detracts from the clinical usefulness of these criteria. Attempts to combine these values and correct for tumour volume, as calculated from computerized tomography, did not improve the differentiation between these two groups. Although it has been reported that plasma NMR and lipid levels can differentiate between malignant and benign tumours in general and in the central nervous system, these criteria are not adequately sensitive and specific to replace histology for the definite diagnosis of central nervous system tumours.
Biomarkers, Tumor↗
Penetrating craniocerebral injury caused by a metal rod: an unusual case report.
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Accidental Falls↗
Delayed epidural hematoma without neurologic deficit.
Six patients with delayed epidural hematoma demonstrated by serial computed tomography scan are presented. Three of the patients had no neurologic deficit but suffered from severe headache. We suggest routinely performing repeat CT, before discharge, in patients having sustained head trauma with or without skull fracture, who suffer non-resolving headache, even when there is no neurologic deterioration. Serious symptomatology that may have occurred due to the development of delayed intracranial hematomas is thereby anticipated.
Adult↗
Hemiballism as a presentation of a meningioma.
A 73-year-old woman with a meningioma presented with hemiballism. This is the report of an unusual presentation of a primary brain tumor.
Aged↗
[Corpus callosotomy in intractable epilepsy].
6 males and 3 females, 2-17 years old, underwent partial or complete corpus callosotomy as treatment for medically intractable epileptic seizures. All benefited from the procedure. Evidence for unilateral cerebral damage on computerized tomography or a nonlocalized focus with secondary contralateral spread were the criteria for patient selection. The best results were obtained in atonic seizures. Long term side effects were minor and were minimized by staging the callosal resection. If partial callosotomy is effective, complete resection is unnecessary.
Adolescent↗
Pudenz antisiphon device tear as a cause of shunt malfunction.
Antisiphon device (ASD) tear was found in nine patients who underwent ventriculoperitoneal (VP) shunt revision of a Pudenz three-piece system. In six cases this was the only finding, in three, there was an associated distal malfunction. Repair of ASD tear constituted 27% of our shunt revision procedures. The locus minoris resistentia of the Pudenz ASD is the attachment of the diaphragm to the cylinder. ASD tear should be suspected whenever a noninflammatory fluid collection of a CSF leak are found at the proximal extracranial section of this system.
Cerebrospinal Fluid Shunts↗
Hypokalaemia in severe head trauma.
Forty-six consecutive patients with severe isolated head trauma (GCS less than or equal to 7) had significant hypokalaemia averaging 3.1 +/- 0.4 (S.D.) mmol/litre upon admission to the emergency room. This electrolyte imbalance occurred within hours of the trauma and resolved under treatment within the first day. There was no correlation between serum potassium and pH, glucose, urine electrolytes, patient age or sex, admission Glasgow Coma Score or the Glasgow Outcome Score. Sixteen patients with multiple trauma but without head trauma had an average serum potassium of 3.5 +/- 1.1 mmolar. Mechanisms of serum potassium level control and their correlation with brain trauma are addressed in a search for an explanation of this phenomenon. We believe that the most appropriate explanation for this hypokalaemia is the large catecholamine discharge that is known to accompany severe head trauma, with resultant beta 2-adrenergic stimulation of the Na+ -K+ pump. The formation of a prospective on-going study to clarify the basic mechanism of hypokalaemia in severe head trauma is presented.
Adolescent↗
Coexistence of Dandy-Walker syndrome and Down's syndrome.
A newborn with Dandy-Walker syndrome was found to have a trisomy 21 karyotype. This is the first reported case of coexisting Dandy-Walker and Down's syndromes. The pathogenetic alternatives for the development of Dandy-Walker syndrome and the implications of the case are discussed.
Cerebrospinal Fluid Shunts↗