Biomedical subjects
Publications and source records attributed to V P Sachdev.
A case of a malignant meningioma within the 3rd ventricle is presented. Although malignant transformation of meningiomas has been described, occurrence within the ventricular system is extremely rare.
Obstruction of the foramen of Magendie unrelated to illness or trauma is rare in adults. Two cases of congenital membranous occlusion of the foramen of Magendie in adults are presented. Analysis of the reported cases of fourth ventricular outlet obstruction disclosed only three similar cases.
A personal series of 300 cases of lumbar disc disease treated by microsurgical lumbar discectomy is presented. Follow-up is available in all cases. Good to excellent results are reported in 94% of the patients. Six patients (2%) have needed repeat surgery at the same level, all with good results. One of these six patients has had third-time exploration at the same level. There has been no mortality; one patient had a superficial wound infection, two suffered from minor pulmonary emboli, and one patient had an MI in the postoperative period. Surgical technique as used by the author is discussed.
A case of delayed onset of C5-6 subluxation after a motor vehicle accident, with normal initial cervical spine roentgenograms and neurological findings consistent with concomitant cerebral trauma, is presented. Damage to the cervical spine was due to fractures of the C-6 body and superior articular facet undetected by routine radiologic studies.
Of 400 patients with ethmoid sinus disease, 18 had undergone craniofacial resection. This operation is an aggressive surgical procedure directed at total en bloc extirpation of tumors that extend through the floor of the anterior cranial fossa. Recent advances in surgical technique have made it the procedure of choice for sinonasal tumors that extend through the cribriform plate, fovea ethmoidalis, and orbital roof. Specifically, this operation has had excellent results in patients with esthesioneuroblastomas. Radiologists must be aware of the possible pitfalls in interpreting the postoperative computed tomographic scans and the findings that suggest tumor recurrence.
A patient with an ependymal cyst of the quadrigeminal plate is reported. The patient presented with headache, diplopia, and evidence of increased intracranial pressure. A nonenhancing cyst with hydrocephalus was demonstrated by computed tomographic scan. The cyst was subtotally resected using a transtentorial approach. The causes, clinical presentation, and treatment of quadrigeminal plate ependymal cysts are discussed, together with a review of the literature.
Only five previous paranasal sinus pneumoceles have been described and all occurred in the maxillary antra. To our knowledge, this is the first case report of a sphenoid sinus pneumocele. Clinically it was seen as recurrent episodes of left-sided blindness occurring only during airplane flights. The roentgenographic findings and the differential diagnosis are discussed.
The triad of hyperprolactinemia, ophthalmoplegia, and radiologic abnormalities of the sell turcica suggest a tumor in the area of the pituitary gland. A new association--bilateral intracavernous carotid aneurysms--is presented. Two elderly women had extraocular muscle palsies and elevated serum prolactin levels of 71 and 32 ng/ml (normal: less than 20 ng/ml). In the former, a high-resolution computed tomography scan made after contrast medium injection was incorrectly interpreted as demonstrating a pituitary tumor; cerebral arteriography revealed bilateral aneurysms. In the other patient, a computed tomography scan after contrast medium injection demonstrated the bilateral aneurysms, and these were confirmed by radionuclide angiography.
An unusual case is reported in which a posttraumatic peudomeningomyelocele developed over many years inside the body of a fractured lumbar vertebra, eroding the pedicle and causing progressive neurological deficit. The wall of the sac was mostly formed by the scalloped bar bone, and partly by a membrane resembling the dura. The terminal part of the conus medullaris and some nerve roots of the cauda equina formed the contents and parts of the wall of the outpouching of the subarachnoid space into the vertebral body. A comparison is drawn between this lesion and formation of an "enlarging fracture" of the skull. The surgical technique used for obliteration of this pseudomeningomyelocele is described.
Two patients are reported with congenital aqueductal stenosis and hydrocephalus, with functioning ventriculoperitoneal shunts, who developed posttraumatic epidural hematomas. Relative paucity of neurological signs in spite of large size of hematomas is discussed.
Two cases of subarachnoid hemorrhage complicating intranasal ethmoidectomy are presented. In both, the bleeding was initally considered coincidental to the rupture of a congenital aneurysm or an arteriovenous malformation. A direct relationship between the surgical procedure and the subarachnoid hemorrhage only became evident after extensive studies or after delayed development of CSF rhinorrhea, pneumocephalus and meningitis.
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An avascular, contrast enhancing intraosseous petrous apex mass was discovered on CT in a patient with prior colonic carcinoma and acute myelocytic leukemia. A normal bone scan made metastasis unlikely and surgery revealed a neuroma. The differential diagnosis is discussed.
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Arteriovenous malformations of the dura are thought to be congenital. However, arteriographic investigations of four patients who, after a head injury, developed dural arteriovenous fistulae with features of congenital malformations suggest that these abnormal communications may also be acquired. Thrombosis or thrombophlebitis in the dural sinus or vein may be the primary event in their formation. The pathogenesis is probably "growth" of the dural arteries normally present in the walls of the sinuses during the organization of an intraluminal thrombus. This may result in a direct communication between artery and vein or sinus, establishing an abnormal shunt. Ultimate fibrosis of the sinus wall and intraluminal thrombus may be the factors responsible for the spontaneous disappearance of such malformations.
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