Ethmoidal encephalocele associated with cerebrospinal fluid fistula: indications and results of mini-invasive transnasal approach.

Anterior skull base defects with encephalocele in adults are quite rare and can be a cause of spontaneous rhinoliquorrhea; however, cerebrospinal fluid (CSF) fistula can be not rarely misdiagnosed for several months or years. Five adult patients affected by ethmoidal encephalocele with CSF fistula were treated in our institute from 2006 through to 2011. Onset of clinical history was represented by rhinoliquorrhea, which was precociously recognized in only 1 patient; in the other 4, it was misdiagnosed for a period ranging from 11 months to 5 years. After clinical diagnosis of CSF fistula and after brain magnetic resonance imaging, ethmoidal encephalocele was evident in all patients; preoperative study was completed by spiral computed tomography scan, to clearly identify the skull base bone defect. All patients were operated on by transsphenoidal endonasal endoscope-assisted microsurgical approach through 1 nostril. The herniated brain was coagulated and removed, and reconstruction of cranial base was performed. Postoperative rhinoliquorrhea or other complications did not occur in any patient at short and late follow-up. All patients were discharged after a few days. Endonasal endoscope-assisted microsurgical approach was effective in exposing and repairing the ethmoidal bone defect; tridimensional vision and wide lateral and superior exposition of the operative field were possible in each patient, thanks to the use of microscope and angulated endoscope

Spinal giant cell tumor in tuberous sclerosis: case report and review of the literature.

Abstract BACKGROUND: Patients affected by tuberous sclerosis (TS) have a greater incidence of tumors than the healthy population. Spinal tumours in TS are reported very rarely and consist mainly of sacrococcygeal and cervical chordomas. METHOD: Case report. FINDINGS: A 21-year-old man, affected by TS, presented a spinal dorsal T2 tumor that caused medullary compression. He underwent decompressive laminectomy and microsurgical excision of a giant cell tumor and an associated aneurysmal bone cyst. Postoperative hypofractionated radiotherapy was performed on the surgical field. At 2.4 years of follow-up the patient reported total recovery of neurological deficits and was free from tumor recurrence. CONCLUSION: Considering this association, which is the first reported in the literature, spinal magnetic resonance imaging with gadolinium should be performed at the onset of spinal pain in patients affected by TS

Post-seismic response and repair of earthquake-damaged reinforced concrete bridges

“In bridge structures, column members are typically designed to be the primary source of energy dissipation during an earthquake. Therefore, reinforced concrete (RC) bridges that are damaged in an earthquake tend to have damage to the column members. While many studies have been conducted on seismic strengthening of RC bridge columns, most are focused on retrofit instead of repair. In addition, the limited research on seismic repair of RC bridges has focused on evaluating the response of individual columns (member level), not the bridge structure (system level), due to limitations in modeling and especially testing of full bridge structures. Local modifications (interventions) from the repair of a member can change its performance, and changes in column member performance can influence the bridge structure performance, especially under seismic loading. This study evaluated the impact of RC bridge column seismic repair on the member level, system level, and community level responses. Numerical simulation was used to model the response of repaired RC bridge columns (member level) and study the post-repair response of a prototype bridge with repaired columns (system level). The model was also extended to develop a methodology to minimize the level of pre-earthquake retrofit such that the RC bridge can withstand an earthquake without collapse, suffering minor or moderate damage that can be rapidly repaired later. Finally, a discrete-event-based simulation model was developed to estimate the time needed to bring the situation under control for a given volume of resources under a variety of scenarios after an earthquake occurs in a case-study community (community response), and to study the sensitivity of the restoration times to different variables”--Abstract, page iii

The Letter Collection of Abelard and Heloise, edited by David Luscombe, translated by Betty Radice and revised by David Luscombe

David Luscombe’s new book becomes the first critical edition of the correspondence of Abelard and Heloise to draw on all twelve of the extant manuscripts. It is also – at long last – the first Latin edition with facing page English translation. The translation used is the familiar 1974 Penguin translation by Betty Radice, revised in 2003 by Michael Clanchy, and now again by Luscombe. This career-capping accomplishment has been many years in the works, possibly since the early 1970s when the a..

Huge Pituitary Adenomas: Dedicated Surgical Technique and Indications for Extent of Tumour Removal in the Modern Era

Transsphenoidal surgery is the most indicated approach not only for small and large pituitary adenomas but also for huge ones. A modified transsphenoidal technique to remove huge pituitary adenomas with marked suprasellar extension (4–8 cm of maximum diameter) resulted very useful in authors’ experience. The technique allowed avoiding the occurrence of a precocious descent of the suprasellar cisternal plane into the sellar plane during tumor removal and its related dangerous consequences. Technique was performed opening at the beginning only the lateral parts of peritumoral dura mater, and after removal of lateral parts of the tumor, the central part of peritumoral dura mater was opened and the central intrasellar and suprasellar parts of the tumor were removed. Comparing the results to similar patients operated by the same authors with standard surgical technique, we observed that total removal was accomplished in 64% of patients treated with modified technique than 45% of patients treated with standard transsphenoidal surgery. Moreover, better results were achieved concerning intraoperative CSF leak, postoperative CSF fistula, and average time of postoperative stay in hospital. For invasive dumbbell-shaped pituitary adenomas, particular therapeutic plans are necessary

transsphenoidal surgery for secreting pituitary microadenomas: results with intraoperative application of absolute alcohol

ABSTRACT Background: Pituitary adenomas represent a quite frequent neurosurgical disease. Secreting pituitary adenomas are represented by PRL, GH, ACTH and TSH tumours; the rate of postoperative hormonal recurrence is not ineligible. Methods: We present 106 patients affected by secreting pituitary microadenomas operated through transsphenoidal approach from 1998 through to 2008; in 54 (group 1) patients, intraoperative absolute alcohol was applied, while in the other 52 (group 2) it was not employed. The indications and the intraoperative technique of absolute alcohol application are presented. Hormonal recurrence was treated by hypofractionated stereotactic radiotherapy and/or medical therapy. Results: Postoperative hormonal and clinical remission was achieved in 50 and 47 patients respectively of group one and group two. At the first follow-up control, after 3 months from surgery, no patient of both groups presented hormonal/clinical recurrence. Six months after surgery, no patient of group one presented hormonal recurrence, while two patients of group 2 presented hormonal recurrence. After 2 years from surgery, two patients of group 1 and 4 patients of group 2 presented hormonal recurrence. Three years after operation, hormonal hypersecretion recurred in three patients of group one and in six patients of group 2. At 5 years follow-up, six patients of group one and 8 of group two presented hormonal recurrence. Conclusions: Intraoperative application of absolute alcohol, in selected cases, resulted useful to achieve better results in secreting pituitary microadenomas concerning both postoperative hormonal recurrence and hormonal persistence

Preliminary results of 45 patients with trigeminal neuralgia treated with radiosurgery compared to hypofractionated stereotactic radiotherapy, using a dedicated linear accelerator.

Abstract Radiosurgery (RS) and hypofractionated stereotactic radiotherapy (HSRT) were performed in 23 and 22 patients respectively for the treatment of trigeminal neuralgia. RS and HSRT were performed with a dedicated linear accelerator (LINAC): an invasive frame (for RS) or a relocatable stereotactic frame fitted with a thermoplastic mask and bite blocks (HSRT) were used for positioning patients. The RS treatment delivered 40 Gy in a single fraction, or for HSRT, the equivalent radiobiological fractionated dose - a total of 72 Gy in six fractions. The target (the retrogasserian cisternal portion of the trigeminal nerve) was identified by fusion of CT scans with 1-mm-thick T2-weighted MRI, and the radiant dose was delivered by a 10-mm-diameter cylindrical collimator. The results were evaluated using the Barrow Neurological Institute pain scale during follow-up (mean 3.9 years). The 95% isodose was applied to the entire target volume. After RS (23 patients), Class 1 results were observed in 10 patients; Class II in nine, Class IIIa in two, Class IIIb in one, and Class V results in one patient. Facial numbness occurred in two (8.7%) patients, and the trigeminal neuralgia recurred in two patients (8.7%). Following HSRT (22 patients), Class I results were achieved in eight patients, Class II in eight, Class IIIa in four, and Class IIIb in two patients; recurrence occurred in six (27.5%), and there were no complications. Thus, both RS and HSRT provided effective and safe therapy for the treatment of trigeminal neuralgia. Patients who underwent RS experienced better pain relief and a lower recurrence rate, whereas those who underwent HRST had no side effects, and in particular, no facial numbness

Anterior Microsurgical Approach to Ventral Lower Cervical Spine Meningiomas

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