Pardatscher K

Chronic extradural haematomas

SummaryWe report 17 cases of chronic extradural haematoma out a total of 411 epidural haematomas treated at the Neurosurgical Department of Padua from 1954 to 1980.The definition, the variations in the presentation, and the CT scan features of chronic epidural haematomas are discussed.

Epidural haematoma at the vertex.

SummaryWe report 14 cases of vertex epidural haematomas among 478 cases of epidural haematomas that were hospitalized in the Neurosurgical Department of the University Hospital of Padova during the period 1953–1980.We discuss the clinical, diagnostic, and prognostic features. The mortality rate was 50%. In this type of traumatic haematoma prompt surgical treatment is not always followed by good recovery.

Traumatic primary brain stem haemorrhage. A clinical and experimental study.

SummaryWe report 36 cases of post-traumatic “primary brain stem haemorrhage” visualized by the CT scan and confirmed at autopsy.Clinical experience shows that many technical factors influence the inability to visualize brain stem haemorrhages. Experimental injection of fresh blood into the pons and midbrain of cadavers shows that lesions as small as 0.25 ml in volume may be visualized.The volume and the anatomical configuration of traumatic lesions of the brain stem extended over a rostro-caudal direction, and their proximity to bony structures at the base of the skull are obstacles to the visualization of brain stem haemorrhages.

Traumatic posterior fossa haemorrhage in children

SummaryWe report ten cases of post-traumatic posterior fossa haemorrhage occurring in children. All patients were studied by CT scan. Five had an intracerebellar haemorrhage, three a brain stem haemorrhage, and two an extradural haematoma. In four cases we have found the coexistence of supratentorial and infratentorial haemorrhagic lesions.The incidence of posterior fossa haemorrhage in children, the importance of linear occipital fracture, the clinical course, the conservative or surgical treatment, and the prognosis are discussed.

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.

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.