Mordechai Shalit

Intracranial meningiomas after high‐dose irradiation

Three patients who presented with intracranial meningiomas 12, 15, and 20 years, respectively, after therapeutic high‐dose irradiation of a primary brain tumor are described. Analysis of these cases and similar documented cases suggests that meningiomas after high‐dose irradiation constitute a recognizable entity. Patients with such tumors received radiation therapy at a young age (mean, age, 9.4 years). After a latent period of 2 to 47 years (mean, 19.8 years) they developed meningiomas at the site of irradiation, at a much younger age than patients with “spontaneous” meningiomas. Similar to the situation with meningiomas after low‐dose irradiation, a relatively high proportion of meningiomas induced by high‐dose irradiation tend to be malignant and biologically aggressive. A very young age at the time of irradiation seems to predispose to the induction of malignant meningiomas, rather than benign tumors. These unusual features provide indirect evidence that high‐dose radiation may play a role in the pathogenesis of meningiomas.

Carcinoma of lung with a solitary cerebral metastasis. Surgical management and review of the literature

During the years 1975 to 1980, 10 male patients and 1 female, with ages ranging between 40 to 61 years, underwent combined resection of primary lung cancer and solitary brain metastasis. In 8 patients the lung cancer was diagnosed and treated first. In those patients, craniotomy for removal of a solitary brain metastasis was carried out 8 to 60 months (mean, 27 months) after excision of the lung tumor. In 3 patients, brain metastasis was diagnosed and treated first and lung excision followed, 2 to 4 weeks after craniotomy. The most common histologic type of the tumor was adenocarcinoma (63.6%). There were no operative deaths. Three patients survived less than 6 months after surgery and were considered as a failure of surgical treatment. Seven patients lived longer than 1 year and three of them are still alive with a follow‐up period between 2 to 3 1/2 years after both operations. One of the patients underwent recently successfully second brain intervention for removal of recurrent histologically identical solitary brain metastasis and is well. Our results and those reported in literature encourage the combined surgical removal of primary lung cancer and a solitary brain metastasis.

The management of obstructive hydrocephalus by the use of external continuous ventricular drainage

SummaryExternal continuous ventricular drainage (CVD) in patients suffering from obstructive hydrocephalus is being used in many neurosurgical centers as a routine procedure for the temporary relief of intracranial pressure. The results of this treatment have been insufficiently evaluated.In the present study two groups of patients were investigated. In one, CVD was never used. In the other one it was used in all cases. It was found that the use of CVD decreased mortality rate most significantly.It is recommended that CVD should be used as a temporary measure for the treatment of the increased intracranial pressure in patients suffering from obstructive hydrocephalus.

Sinus histiocytosis with massive lymphadenopathy and spinal epidural involvement. A case report and review of the literature

A case of “sinus histiocytosis with massive lymphoadenopathy” (SHML) in which spinal epidural involvement caused paraplegia is described. The literature pertaining to this newly recognized entity is reviewed; this review indicates that the process is not necessarily restricted to the lymph nodes and may be progressive in nature. The case we report is the first with histologically proved bone involvement.

Spinal subdural hematoma associated with anticoagulant therapy in a patient with spinal meningioma.

A case of spontaneous subdural hematoma in the cervicothoracic region associated with a small meningioma in a patient on anticoagulant therapy is presented. The neurological complications of anticoagulant therapy are discussed briefly. Progressive neurological deterioration in a patient on anticoagulant therapy should prompt the performance of an emergency myelogram and a possible laminectomy in spite of the potential risks of these procedures. Intraspinal bleeding occurs more frequently in the form of an epidural hematoma, but the clinical presentation may not allow differentiation from a subdural hematoma. The possible causal relation between the asymptomatic spinal meningioma, the anticoagulant therapy, and the formation of the subdural hematoma is discussed.

Neurosurgical management of single brain metastasis

A series of 74 consecutive cases undergoing craniotomy for single brain metastasis in the Beilinson Medical Center between October 1975 and October 1981 were reviewed. All patients underwent radiation therapy after craniotomy. The most common metastasis was that of unknown origin (35%), followed by lung (24%) and breast (16%). Overall median survival after craniotomy was 6.6 months. Overall 1- and 2-year survival rates were 30 and 15%, respectively. Operative mortality (30 days) was 15%. For the patients with metastases to the lung, median survival was 7.5 months and 1-year survival rate was 33%. It appears from this report that two dominant factors affect the prognosis of these patients. The first is the long latent interval (time between diagnosis of primary tumor and detection of metastasis). The second is the location of the metastasis; those with lesions in the cerebral hemispheres had a far better outcome than those with cerebellar lesions (p less than 0.0001).

Experience with intraoperative CT scanning in brain tumors

Abstract Intraoperative CT scanning was used in 10 patients suffering from malignant brain tumors. Follow-up CT scans performed postoperatively indicated that extensive resection of the tumor was achieved in all of the patients. It is suggested that this technique might also be employed in other types of invasive brain tumors.

Brain abscess following dental infection

A 48-year-old woman underwent root canal treatment of the upper left lateral incisor and lower right second premolar. Close to the conclusion of the endodontic treatment she complained about headaches. Later on, because of aggravation of her condition, with headaches, fever, malaise, weakness, and numbness of the right limbs, she was admitted to the hospital. The disease progressed to an epileptic state, with appearance of a right hemiparesis. A brain scan and carotid arteriogram revealed the presence of a mass occupying the left parietal space. Craniotomy disclosed an abscess containing yellow pus from which Streptococcus viridans was cultured. After thorough surgical cleansing of the area, removal of the bone for decompression, and treatment with ampicillin the patient improved gradually and slowly regained the mobility of her right side.

Nasal Visual Field Loss by Intracranial Lesions of the Optic Nerve Pathways

Five patients developed nasal visual field defects as a result of involvement of the intracranial portion of the optic nerves. The cause in each patient, respectively, was as follows: (1) dolichoectatic carotid arteries, (2) optochiasmatic arachnoiditis, (3) meningioma of the olfactory groove, (4) pituitary apoplexy, and (5) pituitary chromophobe adenoma. The common factor in these cases was probably impaired circulation in the prechiasmal arterial anastomotic network. The nasal visual field loss present in these cases was characterized by a pattern similar to that seen in glaucoma but with impairment of visual acuity. The superior nasal visual field was usually normal and the lower temporal visual field often defective.

Cervical intramedullary schwannoma.

A rare case of cervical intramedullary neurinoma is described. Radical excision of the tumor brought about recovery from a severe neurological condition.