J. Goffin

Localized 1H NMR spectroscopy in fifty cases of newly diagnosed intracranial tumors

Fifty patients with newly diagnosed, untreated intracranial tumors were examined with 1H nuclear magnetic resonance single-volume spectroscopy (MRS) using a 1.5 T whole-body MR system. Prior to the MRS, contrast enhanced MR and/or CT imaging studies were carried out. Histological verification was obtained in all patients except one. All tumor spectra revealed distinct abnormalities as compared with the normal brain spectra. Although most meningiomas showed a rather characteristic spectral pattern, generally features specific for the various tumor types were not observed. For instance, though a strong lactic acid signal was seen in most malignant tumors, this signal was also evident in five benign neoplasms.

Outcome of chronic subdural haematoma: analysis of prognostic factors

Prognostic factors for the outcome of patients with a chronic subdural haematoma were analysed in a consecutive study of 260 patients, regardless of the method of neurosurgical treatment. CT findings such as haematoma volume, midline shift and residual subdural collections had no influence on the outcome. The only statistically significant factor of importance for the outcome of patients with chronic subdural haematoma was the neurological condition at the time of treatment. Early diagnosis is therefore of major importance.

Chordoma of the lower cervical spine

Vertebral chordomas are rather rare tumours, especially in the lower cervical region. We present a patient with a C7 vertebral body chordoma and a discussion of pertinent literature is given. Only three C7 chordomas have been reported previously. Diagnosis is sometimes difficult to establish and is based on radiological examinations. Once the histological diagnosis is available, one should aim at a total resection. If this is not possible, adjuvant radiotherapy should be given. For limited cervical lesions, we advise a corporectomy with fusion by an iliac crest graft and osteosynthetic plate stabilisation.

The glossopharyngeal neurinoma: case reports and literature review

Glossopharyngeal neurinomas are rare entities. Only 16 cases have been described so far in the literature. Our experience with 2 cases demonstrates the non-specific and discrete clinical presentation of the ninth nerve neurinoma, but illustrates also some typical radiological aspects, enabling a more precise preoperative diagnosis. Two cases are presented and a survey of the literature is given.

Lateral Safety Limits during a Facial Transclival Approach to the Craniovertebral Junction

Abstract Background : Transclival procedures are infrequently performed and carry some dangerous complications. The carotid arteries and the hypoglossal nerves are the most important structures at risk during the subperiostal lateral dissection of the posterior wall of the oropharynx. These lateral landmarks are, however, not easily identified during the surgical dissection. Methods : We measured the location of the foramen lacerum externum and the hypoglossal canal with respect to the midline. These measurements were performed on 76 non-pathological CT-scanned skulls that were converted into accurate three-dimensional digital reconstruction models by the use of 3D image-processing. The same measurements were also taken on 15 non-pathological skulls by the use of a slide calliper. Results : For the foramen lacerum, the distance to the midline was 11 mm ± 1 mm SD (range 8–14 mm) on the right-hand side and 11 mm ± 1 mm SD (range 9–14 mm) on the left-hand side. For the right hypoglossal canal this distance was 17 mm ± 1 mm SD (range 15–22 mm) and for the left hypoglossal canal 17 mm ± 1 mm SD (range 14–20 mm). There was no significant difference between left and right. Conclusion : The posterior wall of the oropharynx can be safely dissected for at least 8 mm from the midline at the level of the foramen lacerum and for at least 14 mm towards the hypoglossal canal from the midline at the level of the anterior border of the foramen magnum. In addition, this technique with the help of 3D software, can be very useful in the pre-operative setting when performing complex skull base procedures.