First description of cervical intradural thymoma metastasis

Thymoma and thymic carcinoma are rare epithelial tumors, which originate from the thymus gland. According to the World Health Organization there are "organotypic" (types A, AB, B1, B2, and B3) and "non-organotypic" (thymic carcinomas) thymomas. Type B3 thymomas are aggressive tumors, which can metastasize. Due to the rarity of these lesions, only 7 cases of extradural metastasis are described in the literature. We report the first and unique case of a man with cervical intradural B3 thymoma metastasis. A 46-year-old man underwent thymoma surgical removal. The year after the procedure he was treated for a parietal pleura metastasis. In 2006 he underwent cervical-dorsal extradural metastasis removal and C5-Th1 stabilization. Seven years after he came to our observation complaining left cervicobrachialgia and a reduction of strength of the left arm. He underwent a cervical spine magnetic resonance imaging, which showed a new lesion at the C5-C7 level. The patient underwent a surgery for the intradural B3 thymoma metastasis. Neurological symptoms improved although the removal was subtotal. He went through postoperative radiation therapy with further mass reduction. Spinal metastases are extremely rare. To date, only 7 cases of spinal extradural metastasis have been described in the literature. This is the first case of spinal intradural metastasis. Early individuation of these tumors and surgical treatment improve neurological outcome in patients with spinal cord compression. A multimodal treatment including neoadjuvant chemotherapy, surgery and postoperative radiation therapy seems to improve survival in patients with metastatic thymoma

Immunological diagnosis as an adjunctive tool for an early diagnosis of tuberculous meningitis of an immune competent child in a low tuberculosis endemic country: A case report

Background: Pediatric tuberculous meningitis is a highly morbid, often fatal disease. Its prompt diagnosis and treat - ment saves lives, in fact delays in the initiation of therapy have been associated with high mortality rates. Case presentation: This is a case of an Italian child who was diagnosed with tuberculous meningitis after a history of a month of headache, fatigue and weight loss. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis with predominance and decreased glucose concentration. Microscopy and conventional diagnostic tests to identify Myco - bacterium tuberculosis were negative, while a non classical method based on intracellular cytokine flow cytometry response of CD4 cells in cerebral spinal fluid helped us to address the diagnosis, that was subsequently confirmed by a nested polymerase chain reaction amplifying a 123 base pair fragment of the M. tuberculosis DNA. Conclusions: We diagnosed tuberculous meningitis at an early stage through an innovative immunological approach, supported by a nested polymerase chain reaction for detection of M. tuberculosis DNA. An early diagnosis is required in order to promptly initiate a therapy and to increase the patient’s surviva

Meningiomas of the Skull Base: Chapter 12, Middle Fossa Floor Meningiomas

Little is known regarding meningiomas that primarily arise from the floor of the middle fossa as opposed to the other middle fossa meningiomas. In this chapter, we treat this relatively new entity, including primary Meckel’s cave (MC) meningiomas because they respect similar anatomical landmarks. Meningiomas of the middle cranial fossa can be approached by two distinct routes: an anterolateral approach or a lateral approach; in other words, via a pterional or a subtemporal approach. Both approaches can be further extended by means of additional osteotomies, such as the cranio-orbital zygomatic approach and the temporo-zygomatic approach. “Extended” approaches and adequate cerebrospinal fluid drainage, are helpful to achieve a “retractorless” surgical technique. It is also mandatory to achieve good surgical outcomes to preserve venous structures, as the vein of Labbè. The aim of this chapter is to treat “middle fossa floor” meningiomas as a clinical entity that is distinct from meningiomas arising from the sphenoid wing and cavernous sinus, which have been already described in other chapters of this book, and to include in authors’ classification primary MC meningiomas as well

Clinical Assessment of Low Back Pain: A Neurosurgical Point of View

AbstractThe diagnosis of low back pain (LBP) is complex and multifactorial, and a clear etiology responsible for the symptoms is often not detectable. Clinical history and neurological examination are essential for differential diagnosis, because they allow the identification of the specific pathology. The radiological investigation allows to confirm diagnosis, but the indication must always be correlated with clinical findings to not perform unnecessary diagnostic procedures. Management of LBP can involve many specialists – neurosurgeon, orthopedist, physiatrist, physiotherapist – everyone with different knowledge and experience because very often the cause is multifactorial. However, it is mandatory to clarify diagnosis of LBP; in this way, the clinical pathway is fundamental to understand pathogenesis and to determine appropriate treatment

Digital Modernism Heritage Lexicon

The book investigates the theme of Modernism (1920-1960 and its epigones) as an integral part of tangible and intangible cultural heritage which contains the result of a whole range of disciplines whose aim is to identify, document and preserve the memory of the past and the value of the future. Including several chapters, it contains research results relating to cultural heritage, more specifically Modernism, and current digital technologies. This makes it possible to record and evaluate the changes that both undergo: the first one, from a material point of view, the second one from the research point of view, which integrates the traditional approach with an innovative one. The purpose of the publication is to show the most recent studies on the modernist lexicon 100 years after its birth, moving through different fields of cultural heritage: from different forms of art to architecture, from design to engineering, from literature to history, representation and restoration. The book appeals to scholars and professionals who are involved in the process of understanding, reading and comprehension the transformation that the places have undergone within the period under examination. It will certainly foster the international exchange of knowledge that characterized Modernism