Biomedical subjects
Publications and source records attributed to X Morandi.
We report an unusual case of giant adamantinomatous craniopharyngioma in an adult who presented with impaired vision. The intra- and suprasellar tumor extended into the subfrontal, subtemporal and retroclival regions. CT and MRI allowed diagnosis and optimal surgical planning.
We report an exceptional description of a spontaneous chronic spinal epidural hematoma presenting as lumbar radiculitis. The computed tomographic, magnetic resonance imaging, and intraoperative findings are presented. We discuss anatomical and pathophysiological considerations that could lead to such a condition. We estimate that spontaneous spinal epidural hematomas located in the ventral space are in fact premembranous or posterior longitudinal ligament hematomas.
We report a case of a 55-year-old man who experienced spontaneous resolution of a large herniated disc at T8-9. Spontaneous resolution of disc herniation is well known at the lumbar level. This case is a rare example of a large thoracic disc herniation diagnosed by CT and MRI which completely regressed six months after a medical treatment with complete disappearance of symptoms. The mechanism of resolution of a disc herniation is unclear and we discuss theoretical considerations. We emphasize the interest of conservative therapy in patients with thoracic disc herniation without neurological deficit.
Rathke's cleft cysts (RCCs) are non neoplastic epithelial lesions of the sellar region that have been rarely reported as a clinical entity. We retrospectively reviewed the magnetic resonance imaging (MRI), intraoperative, and pathological findings of a series of 16 cases of RCCs operated at our institution since 1992. Concurrently, we discussed the different hypotheses about their embryological origin. The patients included 12 females and 4 males, 11 to 73 years of age. Endocrine disturbance was the most common presentation, followed by headaches and visual impairment. The location of the cyst was intrasellar in 7 cases, intrasellar and suprasellar in 6 cases, and suprasellar in 3 cases. The size of the cyst ranged from 8 to 26 mm (mean 12 mm). MRI signal intensity was quite variable on T1-weighted images. The cyst appeared hyperintense in 6 cases, hypointense in 6 cases, isointence in 3 cases, and heterogeneous in one case. On T2-weighted images (available in 13 cases), the signal intensity was more constant and appeared hyperintense in 11 cases and hypointense in 2 cases. After Gd-DTPA, we did not observe enhancement either of the cyst contents or of the cyst wall, but only of the pituitary gland in all patient. Most often, the pituitary gland was displaced inferiorly by the cyst located above showing a typical image of "an egg in a cup". Fifteen patients were operated upon via the transsphenoidal approach and one upon a frontal craniotomy. Intraoperatively, the cyst contents were gelatinous or thick, and dark colored. In 2 cases, it was cerebrospinal fluid-like corresponding to the signal observed on MRI. The position of the pituitary gland confirmed by surgery in 15 cases coincided with enhancement seen and MR imaging. In 13 cases where biopsy of the cyst wall was performed, it confirmed focally ciliated columnar or cuboid epithelium. A coexistent adenoma was found in one case. In conclusion, we consider that RCCs have varied MRI characteristics so that no pathognomonic sign may be observed. Except in few cases, there were no correlation between MRI and intraoperative findings. Therefore, even with MRI studies, differential diagnoses with others cystic lesions of the sellar region remains extremely difficult. The most interesting findings on MRI studies of RCCs were to locate the pituitary gland to help the surgeon to preserve pituitary tissue during surgery.
Five cases of intramedullary cavernous malformations were retrospectively reviewed. There were 4 women and one man ranging in age from 30 to 67 years. Thoracic spinal cord was involved twice and cervical cord in three cases. Four of them underwent surgery: two improved, one remained stable and symptoms worsened in one. Clinical, radiological features and surgical management are discussed in the light of the follow-up and literature analysis. The role of T2* weighted sequence in MR diagnosis of intramedullary cavernomas is emphasised.
Any variations in the origin of the ophthalmic a. are uncommon and well-explained by the comparative anatomy and human embryology. A unique case is reported of an ophthalmic a. arising from the middle meningeal a. associated with an occlusion of the central retinal a. Embryologic variations which can give such an unusual origin are discussed. Although this association may be fortuitous, we consider that an unusual origin of the ophthalmic a. could be a further factor for an occlusion of the central retinal a.
Auditory brainstem response (ABR) is the reference screening technique for acoustic neuromas, but because of a few false negatives and the increasing performance of magnetic resonance imaging (MRI), its role as the standard method has been questioned. We assessed sensitivity of screening tests in 89 patients with surgically proven acoustic neuromas. Sensitivity of ABR was 92%; 94% for extracanalicular neuromas and 77% for intracanalicular neuromas. For stapedius reflex (SR), sensitivity was 84% and for caloric vestibular response (CVR) 86%. The combined sensitivity of ABR + SR was 97% and of ABR + RS + CVR 98%. For false negatives, the greatest diameter including the intracanalicular portion was always less than 18 mm, with a mean of 15 mm, and none of these tumours reached the brainstem. For patients with unilateral cochleo-vestibular deficit, we propose ABR and SR as first-line screening tests. These tests are repeated at 6 months and at 1 year in the case of normal results. MRI is ordered for patients whose auditory threshold is too low and for those whose ABR or SR results favour retrocochlear disease.
We report an unusual case of spontaneous acute spinal subdural hematoma. To date, only a few cases of magnetic resonance imaging (MRI) demonstration of such a pathology have been reported in the medical literature. We analyse the pathogenesis, clinical presentation, magnetic resonance imaging results, intraoperative findings and prognosis of this rare condition. We would like to stress that prompt and non-invasive diagnosis by MRI sagittal sections leads to efficient surgical treatment.
In this study, the authors present the results of 50 dissections of the anterior choroidal a. in man. Fifty cerebral hemispheres were prepared with the classic techniques of preservation and vascular injection. An ectopic origin was observed in 4% of cases. The intracisternal segment of the anterior choroidal a. forms a neurovascular bundle with the optic tract and basal v. Most of its intraparenchymatous branches arise from the cisternal segment, while branches supplying the optic tract, lateral geniculate body and thalamus arise from the intraplexual segment. Constant anastomoses exist with the vertebrobasilar system, specially the postero-lateral choroidal and posterior cerebral aa. We discuss the importance of an adequate knowledge of the anatomy of the anterior choroidal a. and its relations in the surgical approach to arterial aneurysms and arteriovenous malformations of the region.
The authors report the rare occurrence of an orbital roof fracture associated with extradural and subperiosteal orbital hematoma in a 53-year-old man. This case highlights the clinical association of intracranial extradural hematoma and subperiostal orbital hematoma. It stresses the importance of accurate diagnosis of the etiology of ipsilateral exophtalmos in craniofacial trauma. In this case, surgical removal of the extradural hematoma was warranted, and the subperiosteal blood was removed via a frontal craniotomy. Surgical intervention resulted in a complete recovery without any functional sequelae.