Fuad S. Haddad

Traumatic intracranial aneurysms caused by missiles: their presentation and management

Only 30 cases of traumatic intracranial aneurysm (TICA) secondary to missile injury have been reported to date. To these we add 15 more cases. Missile TICAs are often seen on a secondary branch of the middle cerebral artery and are usually accompanied by a intracerebral hematoma (80%) or by an acute subdural hematoma (26%). Fourteen of our cases were secondary to shrapnel injuries and only one was secondary to a bullet. None of the injuries was through-and-through. TICAs may enlarge in time and, seemingly inoffensive, may rupture and lead to death. All seven TICAs studied histologically proved to be false aneurysms. TICAs are best treated through trapping and excision. The outcome depends on the patients status and level of consciousness before surgery. Indications for angiography are discussed.

Intracranial infection after missile injuries to the brain: report of 30 cases from the Lebanese conflict.

This study reviews the features of 30 intracranial infections complicating 600 penetrating head injuries from missiles in patients treated at the American University of Beirut Medical Center between 1981 and 1988. The follow-up period ranged from 1 month to 7 years (mean, 2.5 years). Sixteen patients had a brain abscess, 9 had cerebritis, 2 had an infected intracerebral hematoma, and 5 had meningitis. Infection developed 4 days to 7 years after the initial debridement. The infecting organisms were Gram positive in 11 patients (36%), Gram negative in 12 (40%), and a combination of Gram positive and Gram negative in 2 (7%). Twenty-four patients (80%) had wound dehiscence or cerebrospinal fluid leakage at the time the infection appeared. There was a 76% correlation between the organisms cultured from the dehiscent scalp wound and the brain. Twenty-three patients had intracranial retention of bone. Infection developed in 16 of the 30 patients (70%) around bone fragments, in 4 around a metallic fragment, in 2 around absorbable gelatin sponge, and in 3 along the missile tract; 2 had an infected intracerebral hematoma, and 3 had meningitis. At least one of the following risk factors was present in each patient: extensive brain injury, coma, trajectory through an air sinus, cerebrospinal fluid fistula, inadequate initial debridement, or incomplete dural closure. The incidence of intracranial infection in patients with postoperative retention of bone was 4% in the absence of scalp wound dehiscence, compared with 84.6% when wound dehiscence was present. Ten patients (43%) still retained a bone fragment measuring less than 1 cm after excision of a brain abscess or treatment of cerebritis or meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment options in primary Ewing's sarcoma of the spine: report of seven cases and review of the literature.

Primary Ewings sarcoma of the spine is reviewed, and seven cases are presented. Ewings sarcoma of the spine is a rare condition that appears with a clinical triad of local pain, neurological deficit, and a palpable mass. The clinical picture, imaging characteristics, and management are discussed. The definitive management of Ewings sarcoma of the spine, as in other locations, could include three main modalities: surgery, radiotherapy, and combination chemotherapy. In the presence of acute neurological decompensation, decompressive surgery via an appropriate approach should be performed. Because Ewings sarcoma is usually sensitive to chemotherapy, initial chemotherapy, in neurologically stable patients, could be attempted first without surgical resection. Further management could then be gauged according to the response.

Extradural spinal angiolipoma

Two cases of extradural spinal angiolipomas are reported. The literature is reviewed and the entity of extradural spinal angiolipoma proposed. A tumor of adulthood, unassociated with bony changes, it occurs mainly in the mid-dorsal spine. Paraparesis progresses over a period of 1-2 years and may wax and wane with pregnancy or body weight changes. Characteristically, the tumor lies over the dorsal aspect of the dura, from which it may be peeled off easily. Its port-wine color contrasts strikingly with the contiguous epidural fat. A benign condition, it responds favorably to surgical excision.

Cranial osteomas: Their classification and management report on a giant osteoma and review of the literature

BACKGROUND Cranial osteomas are regarded by some as very common; yet their classification, symptomatology, and management have been neglected. METHODS We report on a giant enostotic convexity osteoma and have reviewed the medical literature. RESULTS A new comprehensive classification for cranial osteomas is proposed: (1) intraparenchymal, (2) dural, (3) skull base, and (4) skull vault. The latter is in turn, subdivided into exostotic and enostotic variants. Three symptom producing enostotic convexity osteomas have been reported in the world literature. We also describe a giant enostotic skull vault osteoma and propose an original surgical technique used to successfully resect this unusual tumor. CONCLUSIONS Most cranial osteomas are asymptomatic and need not be resected. Those that are symptomatic should be managed properly. Their excision, if nor properly performed, may lead to unforeseen cerebral complications.

Cerebral giant serpentine aneurysm: case report and review of the literature.

We present a case of cerebral giant serpentine aneurysm (GSA) and propose a definition of GSA. Our literature review disclosed only 16 cases, including our own, that fit our criteria. GSAs belong to the subgroup of giant aneurysms, but are distinct from giant saccular and fusiform aneurysms. We discuss their specific characteristics.

An unusual cause for trigeminal neuralgia: contralateral meningioma of the posterior fossa.

Twenty cases of facial neuralgia associated with tumors of the contralateral posterior fossa were collected from the world literature. Only four of these conform to the description of typical trigeminal neuralgia. We report on a fifth such case with a critical review of the literature. Subtotal excision of the tumor improves the pain and may convert a carbamazepine-resistant neuralgia into a responsive one. Total excision is often followed by a cure. Faced with such a case, the tumor should always be excised first, as this usually cures the neuralgia. Surgical treatment of the neuralgia in the presence of the tumor may be followed by disastrous results. An alternative hypothesis to the pathogenesis of the contralateral neuralgia is presented.

Magnetic resonance imaging in intradural and extradural spinal echinococcosis

The potential of magnetic resonance imaging (MRI) in the evaluation of spinal hydatidosis has not yet been fully explored. Only a few sporadic case reports have demonstrated interesting capabilities for detection of cystic echinococcal lesions in and around the spine, but to our knowledge none has described the MRI findings in intradural hydatid cysts. We present two cases of hydatid disease of the spine with extradural and intradural involvement illustrating the value of MRI in the preoperative evaluation, operative planning, and immediate postsurgical results.

Bouguer gravity and crustal structure of the Dead Sea transform fault and adjacent mountain belts in Lebanon

This paper was published in Geology by the Geological Society of America (GSA), and GSA retains the copyright (1993). Geological Society of America, P.O. Box 9140, Boulder, CO 80301-9140 See also: http://www.geosociety.org; http://atlas.geo.cornell.edu/deadsea/publications/Khair1993_Geology.htm

Epidermoid tumors of the fourth ventricle

BACKGROUND Epidermoids of the brain are rare tumors. Their fourth ventricle localization is about the rarest localization. No series of such tumors has been reported. Their manifestations and management are therefore not well understood. METHODS Four epidermoid tumors of the fourth ventricle were collected over a period of 39 years from the neurosurgical units of the American University of Beirut Medical Center and the Orient Hospital. These were retrospectively studied and the medical literature reviewed. RESULTS Epidermoids of the brain form 1% of all brain tumors, and those located in the fourth ventricle are 16.7% of the epidermoids. They rarely present symptoms of increased intracranial pressure. They commonly present in adults with only cerebellar signs. The duration of symptoms may be short, medium, or long. The diagnosis, when clinically suspected, should be confirmed by magnetic resonance imaging. An early diagnosis is the key for a good outcome. CONCLUSION Although a rare condition, these tumors can be lethal if not treated. Total excision should be attempted. Because this tumor is very slow-growing, a near-total excision is acceptable in cases where complete removal may endanger function or life.