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S Spektor

Publications and source records attributed to S Spektor.

13 recordsLinked to original sources
PubMed2001

Application of the orbito-cranial approach in pediatric neurosurgery.

OBJECTIVE: This study evaluates the benefits of and indications for the orbito-cranial approach (OCA) in pediatric patients. METHODS AND RESULTS: The authors report their recent experience of using the OCA in 9 pediatric patients, 6 boys and 3 girls. The patients' ages ranged from 3 to 17 years (mean 9.6+/-5.16 years). Follow-up periods varied between 6 and 21 months (mean 12.6+/-5.9 months). Five patients were operated on for craniopharyngiomas, 2 for chiasmatic-hypothalamic astrocytomas, 1 for a recurrent hypothalamic gangliocytoma, and 1 for a hypothalamic hamartoma. In 7 cases a neuronavigation system (BrainLab) was utilized. The lesions were removed totally in 5 patients, near-totally in 1, subtotally in 2, and partially in 1 patient. An average increase of 30% in the area of vertical exposure significantly decreased the need for brain retraction. There was no mortality in this series. The only complications connected with the surgical approach were transient subgaleal cerebro-spinal fluid collections in 7 of 9 children and a subgaleal-peritoneal shunt placement in another patient. CONCLUSIONS: Our experience with this series of patients suggests that the OCA is as safe and beneficial in pediatric patients as it is in adults. It facilitates tumor removal by providing shorter access to and better exposure of the suprasellar area, thereby minimizing brain retraction.

Adolescent↗
PubMed2001

Transcrusal approach to the petroclival region with hearing preservation. Technical note and illustrative cases.

As a term, the "petrosal approach" to the petroclival region has a variety of meanings. The authors define a common nomenclature based on historical contributions and add new terminology to describe a technique of hearing preservation that allows for greater exposure of the petroclival region. The degree of temporal bone dissection defines five stages of operation. The authors used the second or "transcrusal" stage, in which the posterior and superior semicircular canals are sacrificed while preserving hearing, in six consecutive cases. Use of a common terminology ensures better understanding among surgeons. In the authors' hands, hearing has been successfully preserved in six patients after partial labyrinthectomy.

Adult↗
PubMed2000

CNS granulomatosis in a child with chronic granulomatous disease.

Chronic granulomatous disease (CGD) is a disease in which a granulomatous process involves various organ systems and in which recurrent infections are seen. The basic defect is the absence of the granulocyte respiratory burst. CNS involvement is rare. We present a report of a child with CGD and CNS involvement, presenting with hydrocephalus. Candida was identified in the granulomata. The patient responded well to a CSF shunt and antifungal therapy.

Brain Diseases↗
PubMed2000

Cyst wall enhancement in pilocytic astrocytoma: neoplastic or reactive phenomena.

Cystic pilocytic astrocytomas (CPA) consist of a mural nodule and an accompanying cyst, which may prominently enhance on MRI after contrast administration. This raises the question whether an enhanced wall represents a tumor and thus should be resected together with the solid nodule, as radical tumor surgery is associated with better prognosis. Until now, no systematic histopathological examinations of cyst walls have been reported in correlation with MRI, intraoperative appearance and postoperative clinical and MRI follow-up. We present 3 patients with CPAs and brightly enhanced cyst walls on MRI. Because of the benign, transparent appearance of the cyst wall intraoperatively, it was biopsied but not resected, and only radical removal of the nodule and its immediate surroundings was performed. Separate specimens taken from the cyst wall showed no tumor. MRI performed annually, up to 48-56 months after surgery showed no recurrence of the cyst or the tumor. In such cases of CPA, we suggest that enhancement of cyst walls may represent reactive rather than tumoral tissue, and may be left intact without risking worse prognosis. Mechanisms leading to cyst wall enhancement and the optimal surgical treatment are discussed.

Astrocytoma↗
PubMed2000

Rathke's cleft cyst abscess.

Pituitary abscesses are rare. Occasionally they will arise in pre-existing pituitary pathology. We report such an occurrence within a Rathke's cleft cyst. On the basis of history and imaging, this was indistinguishable from more commonly encountered pituitary pathology.

Acinetobacter Infections↗
PubMed2000

Quantitative description of the far-lateral transcondylar transtubercular approach to the foramen magnum and clivus.

OBJECT: The purpose of this study was to evaluate the far-lateral transcondylar transtubercular approach (complete FLA) based on quantitative measurements of the exposure of the foramen magnum and petroclival area obtained after each successive step of this approach. METHODS: The complete FLA was reproduced in eight specially prepared cadaveric heads (a total of 15 sides). The approach was divided into six steps: 1) C-1 hemilaminectomy and suboccipital craniectomy with unroofing of the sigmoid sinus (basic FLA); 2) partial resection of the occipital condyle (up to the hypoglossal canal); 3) removal of the jugular tuberculum; 4) mastoidectomy (limited to the labyrinth and the fallopian canal) and retraction of the sigmoid sinus; 5) resection of the lateral mass of C-1 with mobilization of the vertebral artery; and 6) resection of the remaining portion of the occipital condyle. After each successive step, a standard set of measurements was obtained using a frameless stereotactic device. The measurements were used to estimate two parameters: the size of the exposed petroclival area and the size of a spatial cone directed toward the anterior rim of the foramen magnum, which depicts the amount of surgical freedom available for manipulation of instruments. The initial basic FLA provided exposure of only 21 +/- 6% of the petroclival area that was exposed with the full, six-step maximally aggressive (complete) FLA. Likewise, only 18 +/- 9% of the final surgical freedom was obtained after the basic FLA was performed. Each subsequent step of the approach increased both petroclival exposure and surgical freedom. The most dramatic increase in petroclival exposure was noted after removal of the jugular tuberculum (71 +/- 12% of final exposure), whereas the least improvement in exposure occurred after the final step, which consisted of total condyle resection. CONCLUSIONS: The complete FLA provides wide and sufficient exposure of the foramen magnum and lower to middle clivus. The complete FLA consists of several steps, each of which contributes to increasing petroclival exposure and surgical freedom. However, the FLA may be limited to the less aggressive steps, while still achieving significant exposure and surgical freedom. The choice of complete or basic FLA thus depends on the underlying pathological condition and the degree of exposure required for effective surgical treatment.

Algorithms↗
PubMed2000

Classification and quantification of the petrosal approach to the petroclival region.

OBJECT: The petrosal approach to the petroclival region has been used by a variety of authors in various ways and the terminology has become quite confusing. A systematic assessment of the benefits and limitations of each approach is also lacking. The authors classify their approach to the middle and upper clivus, review the applications for each, and test their hypotheses on a cadaver model by using frameless stereotactic guidance. METHODS: The petrosal approach to the upper and middle clivus is divided into four increasingly morbidity-producing steps: retrolabyrinthine, transcrusal (partial labyrinthectomy), transotic, and transcochlear approaches. Four latex-injected cadaveric heads (eight sides) underwent dissection in which frameless stereotactic guidance was used. An area of exposure 10 cm superficial to a central target (working area) was calculated. The area and length of clival exposure with each subsequent dissection was also calculated. The retrolabyrinthine approach spares hearing and facial function but provides for only a small window of upper clival exposure. The view afforded by what we have called the transcrusal approach provides for up to four times this exposure. The transotic and transcochlear procedures, although producing more morbidity, add little in terms of a larger clival window. However, with each step, the surgical freedom for manipulation of instruments increases. CONCLUSIONS: The petrosal approach to the upper and middle clivus is useful but should be used judiciously, because levels of morbidity can be high. The retrolabyrinthine approach has limited utility. For tumors without bone invasion, the transcrusal approach provides a much more versatile exposure with an excellent chance of hearing and facial nerve preservation. The transotic approach provides for greater versatility in treating lesions but clival exposure is not greatly enhanced. Transcochlear exposure adds little in terms of intradural exposure and should be reserved for cases in which access to the petrous carotid artery is necessary.

Cranial Fossa, Posterior↗
PubMed1999

Epidural hematoma in infants: a different entity?

BACKGROUND: Epidural hematoma (EDH) in infants may be difficult to diagnose. The mechanism of injury and the clinical presentation are different from those in older children. We characterized the clinical and radiologic parameters of EDH in infants and correlated them with outcome. Because there are no optimal prognostic tools or clear guidelines to perform computed tomography in this unique population, a new approach of neurotrauma scoring is suggested. METHODS: Eleven infants (<2 years old) operated on for EDH were studied. Children's Glasgow Coma Scale (CCS) score was applied, and diagnosis was confirmed by computed tomography. RESULTS: Age was 13+/-5 months. Seven infants (63.6%) fell from less than 1 m. CCS score on admission was 10.7+/-3.9. Five infants (45%) were unconscious, yet two (18.2%) had CCS scores of 15. Pupillary abnormalities were found in two infants and lateralizing signs in five infants. Eight infants (72.7%) had subgaleal hematomas. Mortality and morbidity were 9% each. CONCLUSION: We suggest that a Trauma Infant Neurologic Score be used when dealing with EDH in infants. Lateralizing signs, pupillary abnormalities, mechanism of trauma, and scalp injuries should be included because these are objective relevant parameters.

Accidental Falls↗
PubMed1998

Giant lateral sinus pericranii. Case report.

A case of giant lateral sinus pericranii, which presented in a patient during early childhood as a soft, collapsible mass and gradually grew until it reached 13 x 9 cm when the patient was 36 years of age, is reported. The patient underwent successful surgery and the lesion was totally excised. The results of diagnostic tests (computerized tomography scanning, magnetic resonance imaging, cerebral angiography, and sinusography) and surgery-related problems are presented and discussed.

Adult↗
PubMed1997

Spinal echinococcal cyst: treatment using computerized tomography-guided needle aspiration and hypertonic saline irrigation. Case report.

A multilocular extradural cervical spinal hydatid cyst that causes severe spinal cord compression and quadriplegia is relatively rare and difficult to treat. In a patient with this disorder, computerized tomography-guided needle aspiration of the cyst loculations and irrigation using hypertonic saline eliminated the need for emergency surgery and provided complete resolution of the patient's quadriplegia. The subsequent course of the disease was controlled by treatment with albendazole. Magnetic resonance imaging performed 4 months after the procedure demonstrated collapsed cysts and absence of spinal cord compression.

Bone Cysts↗
PubMed1997

Orbital venous drainage into the anterior cavernous sinus space: microanatomic relationships.

OBJECTIVE: Microsurgical anatomy and relationships in the region of the superior orbital fissure and anterior part of the cavernous sinus were studied, with special attention to the venous structures. METHODS: Microanatomic dissections were performed in 24 specimens from human cadavers, fixed in formalin, with the aid of a microdrill and operating microscope. RESULTS: A protocol of dissection was developed, enabling plane-by-plane exposure of the cranial nerves passing from the cavernous sinus to the superior orbital fissure and farther, on disclosure of the junction between the ophthalmic veins and the anterior cavernous sinus space. The main draining vessel was the superior ophthalmic vein. The inferior ophthalmic vein was much thinner and it was identified in 91.7% of cases. These two vessels fused together to form a common venous confluence approximately 5 mm in length that entered the anterior cavernous sinus space in its anterior or anteroinferior aspect. The shape of this venous drain varied greatly, from that of a typical vein to that of a venous lake. The latter was characterized by a relatively narrow opening into the anterior cavernous sinus space and lacunar widening of the vessel in its central part. No case of a separate entrance of the superior and inferior ophthalmic veins into the anterior cavernous sinus space was encountered. The anterior cavernous sinus space was described as a slit-like venous chamber located in front of the anterior genu of the intracavernous segment of the internal carotid artery. The anteroposterior diameter of this space was 3.2 +/- 0.4 mm; it was filled with blood, and no venous structures inside this space were observed. CONCLUSION: The knowledge of the anatomic details described may be useful for elaborating surgical approaches to this region and for planning the treatment of carotid-cavernous fistulas.

Carotid Artery, Internal↗
PubMed1995

Intracranial haemorrhage from a meningioma in a patient receiving aspirin prophylaxis: a case report.

A case of acute subdural haematoma originating spontaneously from an angiomatous meningioma in a patient receiving prophylactic aspirin therapy is presented. To the best of our knowledge no comparable case and no discussion of possible complications of aspirin prophylaxis in patients with brain tumours have been published. Possible reasons and clinical significance of this complication are discussed. This observation questions the suitability of aspirin as prophylaxis for vascular disease in patients with meningiomas.

Aged↗