Giorgio Iraci

Combined Treatment of Pediatric Medulloblastoma

29 out of 34 consecutive patients of pediatric age, operated upon for posterior fossa medulloblastoma, were divided into 2 groups according to the chemotherapeutic treatment (mtrathecal methotrexate o

Anterior Optic Gliomas with Precocious or Pseudoprecocious Puberty

5 patients with gliomas of the anterior optic pathways, histologically assessed or with strong diagnostic evidence, who developed precocious or pseudoprecocious puberty (2 cases) before the operation or after radiation treatment, are presented. Only 2 patients presented familial and/or personal evidence of neurofibromatosis. The production mechanism of these sexual changes is discussed.

Histiocytosis ‘X’ of the Central Nervous System

The case is presented of a child with early manifestations of Hand-Schuller-Christian disease limited to exophthalmos, and rapid final progression towards a clinical picture dominated by intracranial

Vertebrobasilar transient ischemic attacks: an unusual clinical manifestation of a cervical aneurysmal bone cyst.

Abstract An aneurysmal bone cyst arising from the spinous processes of the second and third cervical vertebrae in a 13-year-old boy became clinically evident as a slightly tender mass. Symptoms were referable to transient ischemia in the vertebrobasilar circulation. After complete removal and irradiation, the patient has no symptoms or signs seven years following operation.

Gliomas of the Optic Nerve and Chiasm

A series of 24 children with anterior optic gliomas, observed and for the most part operated upon in a neurosurgical service, is reviewed. A low incidence of unilateral nerve tumors and of associated neurofibromatosis, and a rather high frequency of precocious or pseudoprecocious puberty were noted in comparison with other series. Most tumors were low-grade growths. The results of surgical treatment reflect a good prognosis for unilateral tumors and an increasing prognostic ominousness for the posterior neoplastic development. Cerebrospinal fluid shunts and radiation treatment do have a role as adjuncts to surgical exploration and biopsy, which are generally indicated since no preoperative test seems to grant an absolute diagnosis. The opinion that chiasmal tumors should not be treated at all is not shared. When the treatment of an illness falls as far short of the ultimate, as does the therapy of neoplastic disease, then it is necessary to reconsider frequently the principles upon which it is based and the results it achieves. These results are two-fold, curative and palliative and, while our efforts are directed toward the former, we realize only too frequently that the best results will sometimes lie in palliation. The disappointment in accepting this lesser goal must not allow us to underestimate its importance or neglect the help it may give.

Opto-chiasmatic arachnoiditis: A review of traditional neuroradiological diagnosis (82 cases, 1951–1976)

SummaryA retrospective appraisal of traditional neuroradiological techniques (such as direct röntgenograms, cerebral angiography RISA-cisternography, and pneumo-cisterno-encephalography, as opposed to the “new” technique of computer-assisted tomography) was carried out in a series of 82 cases of opto-chiasmatic arachnoiditis, all surgically verified. It is concluded that none of these examinations can provide a reliable diagnosis of opto-chiasmatic arachnoiditis, which preoperatively can only be a tentative diagnosis that becomes final only when confirmed by surgical findings. In the presence of certain progressive neuro-ophthalmological symptoms and signs, a negative neuro-radiological investigation should not deter the neurosurgeon from exploring the chiasmatic region. Computer-assisted tomography, of which the authors have no personal experience in these cases, may hold the future answer to the diagnostic problem.

The value and limitations of the CT scan in the diagnosis of giant intracranial aneurysms (two cases)

SummaryTwo cases of giant cerebral aneurysms, the diagnosis of which was made by angiography after a dubious CT scan, are reported.

Tuberculosis and the anterior optic pathways

Sixteen patients (one with tuberculoma of the anterior optic pathways, the other 15 with opto-chiasmatic arachnoiditis) are presented. They are divided into three categories (definite, likely, possible) from the point of view of the pathogenetic link of their optic pathology with a primary tuberculous infection. Neurosurgical treatment had a positive effect upon the visual symptoms in five patients (31.25%), no effect in three cases (18.75%); in the other eight patients (50%) it could not prevent progression of visual impairment.

Opto-Chiasmatic Arachnoiditis in the Young

14 young patients, operated upon for opto-chiasmatic arachnoiditis by craniotomy are presented. 2 main etiopathogenetic forms (and their respective clinical equivalents) of the disease could be recognized. Only 1 postoperative death occurred, in a patient with a dominant clinical picture of intracranial hypertension. Results of surgery (craniotomy and lysis of adhesions) could be distinguished as positive (functional improvement) in 5 cases, indifferent or negative in the others, with a follow-up duration of up to 23 years. The role of the diagnostic value of the pneumoencephalogram as a basis for surgical indication is discussed: it is felt that this examination, when reported as negative, is not of sufficient value to rule out the diagnosis, which must essentially rely upon clinical data.

Opto-Chiasmatic Arachnoiditis Combined with an Intra-Orbital Inflammatory Mass Lesion (Case Report)

The case of a woman with slight diencephalic disturbances, a right exophthalmos caused by an intra-orbital inflammatory mass lesion, and a surgically proven opto-chiasmatic arachnoiditis is reported. Surgery (removal of the intra-orbital mass and of the arachnoiditic adhesions) failed to produce any beneficial effect on the vision of the right eye, which eventually became blind.