The role of hemodynamic assessment in the management of cerebral AVMs

no abstract availabl

Posterior longitudinal ligament cyst causing radiculopathy. Case illustration

[No abstract available

Direct surgery for brainstem tumors

Updating a previous report, the authors offer a review of 45 patients between age 2 and 63 treated by direct surgical excision for brainstem tumours of various description. Since 1986 all candidate patients were examined by NMR imaging in addition to CT scanning, sometimes with the further addition of digital-subtraction vertebral angiography. By Epstein and McLeary's criteria, 24 of the tumours were focal, 12 were cervicomedullary and 9 were diffuse. The most frequent histological diagnosis was glioma (36 cases between low-grade astrocytoma, anaplastic astrocytoma and glioblastoma); the balance was provided by cavernoma (6 cases), haemangioblastoma (2 cases), and lipoma (2 cases). Gross total resection was achieved in 28 patients, namely all those with ependymoma or vascular tumours and 14 of 17 with low-grade astrocytoma. Resection was subtotal in 16 cases and confined to a generous biopsy in one. There was no operative mortality, but 2 deaths occurred in the early postoperative period. At discharge, neurological status was unchanged or improved in 35 cases. At 3-month follow-up examination, 12 patients were improved, 27 were unchanged and 3 were worsened. By January 1990 (6 to 72 months postoperatively) 27 of the first 40 patients treated were alive: 13 had resumed normal life, 6 were self-sufficient and 8 were disabled. The authors conclude that present-day microsurgical resection of intra-axial brainstem tumours is associated with low mortality and morbidity and affords favourable results for which they credit high-quality NMR imaging, efficient microsurgery, adequate anesthesia, and competent postoperative intensive care

Endosellar meningiomas: report of 2 cases and review of the literature

Two cases of endosellar meningiomas are presented. The clinical and radiological picture is not always sufficiently specific to distinguish meningiomas from other types of sellar lesions, but pre-operative diagnosis is of fundamental importance in choosing the best surgical approach. In both cases, the transsphenoidal approach was used, and due to the dense consistency of the tumors, only biopsies were performed. One of the two patients was reoperated on using the sub-frontal approach for radical removal of the tumor. In the authors' experience, craniotomy proved to be the more favorable approach than the transsphenoidal route for radical excision of endosellar meningiomas. Literature on the classification of sellar meningiomas for radiological diagnosis and surgical strategy of endosellar meningiomas is reviewed