Retrosigmoid approach for a ruptured pontine cavernous malformation, in a 10 years old pacient: Case report

Brainstem cavernous malformations have a high risk of hemorrhage, ranging from 4 to 60%, this risk being even higher in children where larger lesions are encountered. Even small hemorrhages can cause ,severe neurological symptoms because of the high density of cranial nerve nuclei and fiber tracts within the brainstem. The goal of surgical treatment is not only the improvement of neurological symptoms, but also preservation of the patient’s quality of life. We present a case of a 10 years old female pacient who presented after a 5 weeks conservative treatment with right sided weakness and loss of coordination, right hemihipoesthesia, She was diagnosed with a large left pontine cavernous malformation on MRI. The cavernoma was resected using a retrosigmoidian approach , but a small remnant was left, when the surgery had to be stopped due to severe bradicardia. The neurological deficit improved at follow up.The choice of the surgical approach that allows the best exposure of the lesion is mandatory. In this case the lesion was evident on the surface of the brainstem and this facilitated its resection. Traction on the tumor and coagulation near the cranial nerves nuclei should be avoided, but if bradicardia appears the surgery must be stopped.Surgery is the best choice for the patients with symptomatic brainstem cavernomas that present with hemorrhage and neurological deficit, and its objectives should be complete removal and improvement of neurological deficit.&nbsp

Surgical treatment and outcome of cerebral cavernomas: A 10 years’ experience

Cavernous malformations (cavernomas) are congenital low flow angiographic occult vascular lesions with a high tencency to bleeding. The prevalence of cerebral cavernous vascular malformations is estimated to be 0.4% to 0.9%.2,7 CMs in deep locations, including the brainstem, thalamus, and basal ganglia, account for 9% to 35% of all malformations in the brain. We performed a retrospective 10 years study on 130 operated cerebral cavernomas and discussed the clinical status at presentation, the choice and timing of the surgical approach and the short and longterm follow up. The 130 operated cases were divided into a supratentorial 102 (78.46%) group and an infratantorial group 28 (21.53%). The average age at presentation was 43,62 years old (17-76) and there was no sex predominance, male/female = 1,44 (77/53). Only in 14 cases (10.76%) we could find multiple cavernomas which had relatives with multiple cavrnomas, but the familial inheritance was not studied, and only the symptomatic lesion was resected. We divided the outcome results reporting for agroup with superficial respectively profound lesions. The long term follow up for the patients in the profound lesions group showed that 31/37 (83,78%) of patients had a mRS between 0 and 2, and the rest had a poor long term outcome. After surgery there was no clinical deterioration in the superficial lesions group and 22 patients from those who presented in mRS 2 showed neurological improvement on long term follow up, meaning that 82,79% of patients had a 0 or 1 mRS. Microsurgery is the treatment of choice in symptomatic brain cavernomas, total resection being the only curative treatment, capable to prevent further bleeding and to offer an efficient control of seizures.Key words: cavernous malformation, microneurosurgery, seizures

Clip reconstruction of a large right MCA bifurcation aneurysm: Case report

We report a case of complex large middle cerebral artery (MCA) bifurcation aneurysm that ruptured during dissection from the very adherent MCA branches but was successfully clipped and the MCA bifurcation reconstructed using 4 Yasargill clips. Through a right pterional craniotomy the sylvian fissure was largely opened as to allow enough workspace for clipping the aneurysm and placing a temporary clip on M1.The pacient recovered very well after surgery and was discharged after 1 week with no neurological deficit. Complex MCA bifurcation aneurysms can be safely reconstructed using regular clips, without the need of using fenestrated clips or complex by-pass procedures

Cellulose acetate membranes functionalized with resveratrol by covalent immobilization for improved osseointegration

Covalent immobilization of resveratrol onto cellulose acetate polymeric membranes used as coating on a Mg-1Ca-0.2Mn-0.6Zr alloy is presented for potential application in the improvement of osseointegration processes. For this purpose, cellulose acetate membrane is hydrolysed in the presence of potassium hydroxide, followed by covalent immobilization of aminopropyl triethoxy silane. Resveratrol was immobilized onto membranes using glutaraldehyde as linker. The newly synthesised functional membranes were thoroughly characterized for their structural characteristics determination employing X-ray photoelectron spectroscopy (XPS), infrared spectroscopy (FT-IR), Raman spectroscopy, thermogravimetric analysis (TGA/DTG) and scanning electron microscopy (SEM) techniques. Subsequently, in vitro cellular tests were performed for evaluating the cytotoxicity biocompatibility of synthesized materials and also the osseointegration potential of obtained derivatised membrane material. It was demonstrated that both polymeric membranes support viability and proliferation of the pre-osteoblastic MC3T3-E1 cells, thus providing a good protection against the potential harmful effects of the compounds released from coated alloys. Furthermore, cellulose acetate membrane functionalized with resveratrol exhibits a significant increase in alkaline phosphatase activity and extracellular matrix mineralization, suggesting its suitability to function as an implant surface coating for guided bone regeneration

Confidence does not mediate a relationship between owner experience and likelihood of using weight management approaches for native ponies

Funding: This study was funded by Mars Petcare and is part of a PhD studentship funded by the Scottish Funding Council Research Excellence Grant (REG). Authors WR and MN receive salary support from the Rural and Environment Science and Analytical Services Division (RESAS). With the exception of PH (employed by the funding organization), the funding organization did not have any additional role in the conceptualization, methodology, investigation, data curation, formal analysis, decision to publish, or preparation of the manuscript. PH was involved in study design, data interpretation, and manuscript preparation.Peer reviewedPublisher PD

Advanced Scanning Electron Microscopy Methods and Applications to Integrated Circuit Failure Analysis

Semiconductor device failure analysis using the scanning electron microscope (SEM) has become a standard component of integrated circuit fabrication. Improvements in SEM capabilities and in digital imaging and processing have advanced standard acquisition modes and have promoted new failure analysis methods. The physical basis of various data acquisition modes, both standard and new, and their implementation on a computer controlled SEM image acquisition/processing system are discussed, emphasizing the advantages of each method. Design considerations for an integrated, online failure analysis system are also described. Recent developments in the integration of the information provided by electron beam analysis, conventional integrated circuit (IC) testing, computer-aided design (CAD), and device parameter testing into a single system promise to provide powerful future tools for failure analysis

Giant extracranial liposarcoma: Case report

Objective: Anaplastic liposarcoma of the head is an extremely rare entity. Seventy-seven cases of head and neck liposarcomas have been reported in the world literature since 1911. Radical surgery is the form of treatment advised.Clinical presentation: Authors report the case of a 62 years old female patient admitted in our institution for a giant extracranial tumor (122/88 mm), developed insidious over a period of 3 years and neglected. The patient agreed surgery only for the epicranial tumor. The lesion was completely removed. Postoperatory outcome was excellent concerning this tumor, although the histopathological result was not that great: high anaplastic liposarcoma.Conclusion: Liposarcoma of the scalp is rare. Diagnosis is made histologically. The histopathologic variant influences clinical behavior and prognosis. The treatment of choice is wide surgical excision.&nbsp

5 years experience in epidermoid and dermoid cysts: Case presentation and literature review

Introduction: Intracranial epidermoid and dermoid cysts are the result of an embryogenesis dysfunction leading to an abnormal migration of ectodermal cells characterised by a slow and benign rate of growth which is associated with minimal neurological symptoms in large or giant tumors. Materials and methods: We retrospectively reviewed the case files of 17 patients with epidermoid and dermoid cysts operated using the operative microscope and neuronavigation in our department between January 2011 and December 2015. Results: Reviewing the case files we selected fourteen patients with epidermoid cysts and 3 patients with dermoid cysts who underwent surgical resection. Most of the cysts were located infratentorial (64%) with a propensity for the CP angle (81%). Total resection was attempted in all cases but was possible in only 13 cases. All cases with subtotal resection were infratentorially located in close relation to the brainstem or cranial nerves. Conclusion: When the tumor extension reaches beyond the limits of the surgical approach used, the tumor remnant should be addressed in a second surgery. Using the cysternal anatomy and the vessels dissection technique the risks aseptic meningitis and of injuring the cranial nerves are diminished

Update on the natural history of infratentorial cavernous malformations

Infratentorial cavernous malformations are still a source of serious controversies in neurosurgery and their natural history and treatment are intensely debated in literature. Recent studies suggest that symptomatic infratentorial cavernous malformations have a more aggressive clinical outcome than the supratentorial ones (the risk of hemorrhage is approximately 30 times that of the supratentorial cavernomas) The optimal therapeutic approach of infratentorial cavernomas need a good understanding of the natural history and also the characteristics that may influence the associated neurological risk, like the patient status at admission, the localization and the genetics of the malformation. Many studies have been published in the last decades to enlight the clinical aspects and the natural history of these vascular malformations. The purpose of this analysis is to make a literature review of the morbidity risk associated to cavernous malformations and their influence on the treatment plan