Venceslao Wierzbicki

A Poorly Known Cerebrospinal Fluid Shunt Complication: Miyazaki Syndrome

We studied a poorly known form of cerebrospinal fluid hypotension characterized by cervical myelopathy, a considerable growth in volume of the venous plexus of the cervical spine, and absence of headache. This form was first described by Miyazaki. We reported a case brought to our attention, reviewed the literature, and formulated etiopathogenic theories that might explain all the various clinical aspects of this pathology.

Intramedullary melanocytoma: case report and review of literature.

We report on a very rare case of dorsal intramedullary melanocytoma in a 62-year-old man. The tumor was resected and gross total removal was achieved. During a 2-year follow-up period in which no radiotherapy was given, the tumor did not recur. We review the literature on these tumors and present disease criteria to distinguish melanocytoma from primary malignant melanoma. Patients and investigators should be cautioned that an intramedullary melanocytoma may recur and give rise to metastatic spread via the cerebrospinal fluid.

Chondromyxoid Fibroma of the Skull Base: Our Experience with an Elusive Disease

Abstract Chondromyxoid fibroma (CMF) is an extremely rare lesion of the skull base. This histologic type typically predilects metaphysis of the long bones. It is locally invasive/infiltrative, and this tendency is more concerning in the skull base, where a radical resection is often technically impossible because of the presence of vital neurovascular structures. We present a case of a 19‐year‐old woman who presented with a sudden onset of right facial weakness, progressively worsening to a severe disfiguring motor weakness. Gadolinium‐enhanced brain magnetic resonance imaging showed an osteolytic lesion located in the right mastoid involving the stylomastoid foramen and the right seventh cranial nerve. A partial mastoidectomy was performed, with an excellent rate of tumor resection and complete local control of the disease at follow‐up. The analysis of current literature indicates that a radiologic diagnosis is rarely strictly convincing of CMF. Histologic diagnosis is often difficult due to the lack of a specific immunohistochemical pattern of chondrosarcoma. Surgery is currently recognized as the mainstay to manage this lesion, although a trend toward adjuvant radiation therapy (RT) currently is seen. Although a tendency of local recurrence is well recognized in the literature, the very slow and indolent behavior of this lesion plus the trend to enhance local control of the disease with high‐dose RT pushed us to a reappraise the role of radical skull base surgeries burdened by the risks of major complications, cosmetic deformities, and additional neurologic deficits.

Preoperative Volumetric Assessment Matched with High-Field Intraoperative Magnetic Resonance Imaging-Guided Stereotactic Evacuation of Brain Abscesses

OBJECTIVE AND BACKGROUND Stereotactic evacuation is currently accepted as a minimally invasive surgical procedure for the management of brain abscesses. Intraoperative magnetic resonance imaging (Io-MRI) is well established in neuro-oncology but its role has not been completely outlined for brain abscess surgery. The objective of this work is to analyze radiologic, clinical, and laboratory results in a cohort of patients with brain abscesses treated with an original protocol in which the minimally invasiveness of a stereotactic technique is matched with preoperative volumetric evaluation and Io-MRI. METHODS For each of the 12 patients included in this cohort, the following data were recorded: age, sex, location, presentation, grade of evacuation, duration of follow-up, mean preoperative and postoperative Glasgow Outcome Scale score, functional outcome, number of abscess loculations, number of Io-MRI, duration of antibiotic therapy, preoperative and postoperative laboratory findings, pathogen strains and possible recurrences. RESULTS The operative time was in 10/12 patients under 90 minutes. A total of 8/12 patients needed no more than 30 days of antibiotics; 9/12 patients had minor or no sequelae and returned to normal activities; only 1 recurrence of brain abscess was recorded in the sample. Only 1 death was recorded in the sample. CONCLUSIONS Although this work is intended to present preliminary results of an original protocol for the management of brain abscess, the role of a precise preoperative volumetric evaluation matched with Io-MRI in the treatment of this disease seems of great benefit, as in surgical neuro-oncology.

How old is your cervical spine? Cervical spine biological age: a new evaluation scale

PurposeThis article aims at presenting a scale that, through the analysis of MRI images, clearly charts the various degenerative stages of the cervical spine and establishes its biological age. We have created this scale by summing together various scores linked to a selection of parameters according to which MRI images are analyzed.MethodWe examined 423 cervical spine MRI scans, belonging to patients who had been admitted to the Medical Imaging Service of the Military Hospital of Rome between January 2010 and July 2011. We selected 6 parameters for the analysis of the MRI scans of the cervical spine: (1) the degeneration of the intervertebral discs, (2) the degeneration of the yellow ligaments, (3) the degeneration of the vertebral bodies, (4) the possible presence of spondylolistheses, (5) the presence or absence of foraminal stenosis, and (6) the diameter of the spinal canal. We assigned to each parameter a score system based on a graduated scale. The cervical spine physiological age can be determined by summing up the scores obtained for each parameter.ResultsWe submitted the data obtained from the study to a statistical enquiry. The results of the enquiry confirmed the suitability of the parameters selected for the evaluation of the aging process of the cervical spine.ConclusionsThe effectiveness of the various treatments for cervical spine degenerative disorders is influenced by the overall anatomical conditions of the cervical spine. Up until now there has been no objective criterion for the evaluation of these anatomical conditions. We believe that this scale will be a useful tool to homogenize retrospective studies and to correctly set up prospective studies on the degenerative conditions of the cervical spine and relative treatments.

Ancient Schwannoma of the Cauda Equina: Our Experience and Review of the Literature

Ancient schwannomas (AS) are exceedingly rare variant of common schwannomas (CS). Only two cases involving the cauda equina region have been previously reported in literature. AS are typically associated with a higher histological degree of degenerative changes (Antoni B areas). It is of peculiar importance, according to our opinion, to outline that, because of their extremely slow growth (which explains the increase of the degenerative changes in respect to the CS) and their typical soft consistency in respect to their standard counterparts, AS usually imply an even better prognosis.

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up

BackgroundThe degenerative lumbar spinal stenosis is one of the most commonly treated spinal disorders in older adults; despite its increasing frequency, it is not yet clear what the most effective therapy might be. The aim of this study is to investigate the very long term results of a homogenized cohort of patients suffering from lumbar spinal stenosis: the first subset of patients operated on with laminectomy and the second subset of patients was also advised to undergo laminectomy but never operated on.MethodsPatients from both subgroups were advised to undergo surgery, according to the same criteria, in the period between 2000 and 2010 and were re-evaluated in the period between January and December 2016.ResultsComparing the two subsets of patients, both suffering from clinically relevant LSS, the first subset returns a statistically significant clinical improvement at follow-up. The rate of excellent results decreases over years. Iatrogenic spinal instability incidence was found to be 3.8% in the present cohort.ConclusionsAlthough the improvement of the first postoperative years decreases over time and despite the lack of general consensus, the lack of established shared guidelines and the limitations of this research, the results support the utilisation of surgery for the management of this condition.Level of Evidence3.

A primary intraosseous cystic meningioma: Case report

Highlights • Intraosseous cystic meningioma is a very rare.• There are no reports of similar cases in the last 30 years.• Primary intraosseous meningioma is a subtype of primary extradural meningioma.• Cystic meningioma is rare, 2–4% of all meningiomas.• A meningioma with both characteristics is an exceptional occurrence.

A very rare case report of long-term survival: A patient operated on in 1994 of glioblastoma multiforme and currently in perfect health

Highlights • Glioblastoma is the most common and most aggressive type of brain tumors. Prognosis is poor: death occurs within 12–18 months from diagnosis.• There is however a small percentage of Patients affected by glioblastoma who survive 3 years or longer.• There are some exceptional cases when people have survived decades after surgical removal of a glioblastoma without any recurrence.• We report a case of a 44 year-old man operated for a glioblastoma. 22 years after surgery the patient has no recurrence of the tumor.• Long-survival depends on young age, complete surgical excision, good Karnofsky index score, radiotherapy and molecular make-up of glioma.

A Blast of Mistakes: Undiagnosed Cervical Spondylolisthesis Following a Bomb Explosion

Patient: Male, 20 Final Diagnosis: Cervical spondylolisthesis Symptoms: Cervical pain Medication: — Clinical Procedure: Surgery with cervical traction and circumferential arthrodesis Specialty: Neurosurgery Objective: Patient complains/malpractice Background: A case of spinal trauma had an unusual clinical course due to medical mistakes, from which we can learn some important lessons. Case Report: We report a case of spondylolisthesis following a bomb explosion, which went undiagnosed for a long time because of a series of mistakes that are highlighted in this article. What makes this case unique is that the spondylolisthesis developed during hospital stay, but the patient had no loss of mobility, strength, or sensitivity. Conclusions: This case shows that establishing the conditions of an organ or a body part upon admission to hospital may not be enough when a patient has suffered extensive and serious trauma, and that it is necessary to carry out more checkups over time, especially if there are new clues and symptoms.