Juana Schiffer

Symptomatic patients after craniectomy

Various surgical procedures in neurosurgery end with cranial vault defects. It is generally believed that the reason for repair of the skull defect is cosmetic or protective. There is evidence, however, that in selected cases neurologic deterioration can be reversed by cranioplasty. In the sinking scalp flap syndrome the deterioration has been thought to be related to the concavity of the skin flap and underlying brain tissue secondary to atmospheric pressure and also to the in-and-out displacement of the brain through the skull defect. Five cases of symptomatic patients after craniectomy are reported, of which all had a neurologic deterioration that was improved by cranioplasty.

Posterior Fossa Lesions Associated with Neuropsychiatric Symptomatology

We reviewed 7 cases with posterior fossa structural abnormalities (3 tumors, 2 megacisterna magna and 2 Dandy-Walker syndrome) presenting with neuropsychiatric symptomatology. Derangement in the balance of dopamine, serotonin and noradrenergic networks has been implicated in the pathogenesis of schizophrenia, affective and even personality disorders. Disruption of the cerebellar output to mesial dopaminergic areas, locus coeruleus and raphe nuclei, or deafferentation of the thalamolimbic circuits by a cerebellar lesion may lead to behavioral changes. Seven patients (pts) (comprising 4 men and 3 women with mean age 22 years) were diagnosed as suffering from psychosis (2 pts), major depression (1 pt), personality disorders (2 pts) and somatoform disorders (2 pts) (DSM-IV criteria). Brain CT scan (7 pts) and MRI (4 pts) revealed tumors of the posterior fossa (2 pts), megacisterna magna (2 pts) and Dandy-Walker variant (2 pts). In one patient a IVth ventricle tumor was removed in childhood.

Meningiomas after radiotherapy for tinea capitis--still no history.

Aims and background To review the clinical, radiological and histological findings of 19 patients with radiation-induced intracranial meningiomas treated at our neurosurgical department between 1981 and 1996. Method The records of 18 patients with intracranial meningiomas who underwent low-dose radiation for tinea capitis in childhood, and of one patient irradiated for pituitary adenoma, were analyzed in respect of the previously reported features of postradiation meningiomas. Results The mean age of the patients with low-dose radiation-induced meningiomas was 58 years and the mean shortest onset latency was 48 years. The male to female ratio was 1.1:1. Forty-seven percent of patients presented with mental changes and/or focal neurological signs, 21% with signs of increased intracranial pressure and 26% with seizures. Calvarial location of the meningiomas was found in 54% of patients and in one patient the tumor arose from the skull base. Multiple tumors were present in 15% of patients and 29% of the meningiomas displayed malignant features on histological examination. A significantly lower meningioma recurrence rate was found in our series compared to the recurrence rate in the reported series of postradiation meningiomas. Five patients had a history of a second neoplasm other than meningioma. Conclusion Our series of low-dose radiation-induced meningiomas represents one of the largest of its kind in the English literature. The patients did not differ substantially in sex ratio, tumor localization, multiplicity and histological features from the previously reported postradiation meningioma patients, except for the significantly lower tumor recurrence rate. It would seem that over the next years we will be further witnessing the deleterious effects of low-dose radiation administered in childhood.

Spinal Dysraphism in the Cervical and Dorsal Regions in Childhood

Spinal dysraphism entirely confined to the cervical or dorsal levels is uncommon. In a large series affecting all levels, only 26 such cases that required operation were found. These are described in order to determine their particular features which include a high incidence of expanding lesions (dermoid cyst and neurenteric cyst) and are therefore associated with a much higher risk of morbidity than dysraphism, at lower levels.

Polysomnography in patients with intracranial tumors before and after operation

Objective – To evaluate the breathing and sleep patterns in patients with brain tumors before and after operation, and assess their relation to the location and size of the tumor, as well as to the post‐operative outcome.

Multiple Meningiomas in Separate Neuroaxial Compartments in a Child

A case of a child with multiple meningiomas in separated neuroaxial compartments is reported. The first tumor was in the frontal region and was removed surgically when first diagnosed 8 years prior to the appearance of the other tumor. The second tumor was located in the foramen magnum region, and reached considerable dimensions before becoming symptomatic and giving signs of brain stem compression as evidenced by progressive spastic tetraparesis and respiratory disturbances, without hydrocephalus. The diagnosis was confirmed by a low CT scan section, the tumor was successfully removed with the aid of the microscope and the patient made a good recovery.

Indication to surgical management of cerebellar hemorrhage

Few reports have compared patients operated for cerebellar infarcts with those operated for cerebellar hemorrhage. Considering our previous paper about patients with massive cerebellar infarcts, we report on our surgical experience with five patients with cerebellar hemorrhage. The indication for operation was decreased consciousness with signs of brainstem compression. In all patients hydrocephalus was absent or mild, as opposed to patients with cerebellar infarcts. Suboccipital craniotomy with hematoma evacuation was therefore the surgical procedure of choice. The outcome was worse than in patients with cerebellar infarcts. We conclude that depressed mental state in cerebellar hemorrhage is mainly due to pressure of the cerebellum on the activating reticular system of the brainstem. The surgical approach to patients with bleeding in the cerebellum differ somewhat from that of patients with cerebellar infarcts in timing and kind of first choice procedure.

Clinical Determinants of Long-Term Survival in Patients with Glioblastoma Multiforme

Repeated reports of more than ten years postoperative survival in patients with glioblastoma multiforme (GM) have appeared in the literature over the last decades. Authors have tried to identify the clinical, therapeutic and histological features determining long-term survival. We present two patients in whom, after radical removal of the tumor followed by conventional radiation, there has been no recurrence for at least ten years. The young age of the patients and the radical surgical approach were in accordance with previous reports of long-term survival. Nevertheless, one tumor originated from the thalamus, a location considered to be of unfavorable prognosis. We therefore further discuss the value of clinical signs as determinants in the prognosis of GM.

Hydrocephalus due to bilateral obstruction of the foramen of Monro: a ‘possible’ late complication of mumps encephalitis

Abstract Hydrocephalus due to bilateral obstruction of the foramen of Munro in a 9-year-old girl was diagnosed 4 years after mumps meningoencephalitis, and is presented in this case report suggesting a possible association with late complication of mumps virus, providing further circumstantial evidence of the role mumps virus may play in the pathogenesis of hydrocephalus.

Electroencephalographic Abnormalities in Aseptic Meningitis and Noninfectious Headache. A Comparative Study

Background.—The finding of abnormalities on electroencephalogram (EEG) during the course of aseptic meningitis is often considered to be indicative of parenchymal brain involvement, even in absence of clinical signs of encephalitis.