Traumatic lumbar Spondylolisthesis: Case Report

Only few cases of traumatic spondylolisthesis (from the cranial to lumbosacral joint) have been reported to date. Recovery of neurological function is dependent on the time of decompression and stabilization. We highlight the paramount importance that the time past between injury and surgical decompression have on neurological recovery and implant durability. Authors present the case of a 26 years old patient who suffered a motor crash 10 days ago before admission in our institution for cauda equina syndrome (L5 level). He also presented abdominal trauma with left kidney contusion, spleen contusion, thoracic contusion and left fibular fracture. X-ray and MRI examinations of the lumbosacral spine revealed grade 3 of spondylolistesis (60% anterior dislocation L5 - S1, intervertebral disc and posterior ligaments laceration, severe compression of the dural sac and dural laceration with CSF leakage through the posterior muscular mass). Surgery performed 14 days after the injury consisted in a posterior approach with L5 laminectomy, dural decompression and duroplasty with fascia lata, segmental reduction and stabilization with transpedicular screws, L5-S1 discectomy and anterior intervertebral grafting with two tricortical iliac crest grafts. Posterior lumbar interbody fusion was carried out using titanium screws (Solas system). Decompression, reduction with L5, S1 pedicular screw fixation, L5 – S1 disc excision and anterior intervertebral grafting with two tricortical iliac crest grafts is an appropriate surgical technique wich offer a good stabilization and fine functional recovering

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

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

Endoscopic Endonasal Transsphenoidal Approach in the Management of Sellar and Parasellar Lesions: and Standard Surgical Technique (Part I)

Transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. In the past decade, however, the endoscopic endonasal transsphenoidal approach has been proposed as a minimally invasive procedure for the treatment of pathologies of the sellar region. This procedure introduces various advantages compared with the transsphenoidal microsurgical approach, such as an improved vision of the surgical field, less traumatism of the nasal structures and reduced complications. Patients’ quick recovery, short hospital stays and minimal postoperative discomfort have been observed. More recently, the standard endoscopic endonasal technique has been extended to provide access to parasellar lesions. This expansion carries significant potential for the resection of skull base lesions. In this article, the authors review the indications of the endoscopic endonasal transsphenoidal approach and define the main phases of the standard surgical technique. Preoperative evaluation, equipment, preoperative and postoperative care are presented. Endoscopic endonasal technique is a safe and effective method for removal of most sellar and some parasellar masses, providing more complete lesion excision and reducing complications

Endoscopic endonasal transsphenoidal approach in the management of sellar and parasellar lesions: Alternative surgical techniques, results, complications (Part II)

The endoscopic endonasal transsphenoidal approach is a minimally invasive surgical technique for the removal of sellar and parasellar lesions. It allows panoramic vision of the surgical target and surrounding structures, with minimal trauma and a low complication rate. The procedure has been gaining in popularity in recent years. There are now surgical instruments intentionally conceived to respond to the specific characteristics of the neuroendoscopy. The widespread use of the endoscope in transsphenoidal surgery has recently contributed to the extension of the approach superior, inferior or lateral. This expansion carries significant potential for the resection of skull base lesions. For selected patients, the various techniques of the endoscopic endonasal transsphenoidal approach are valid alternatives to transcranial approaches. Macroadenomas, suprasellar or even intraventricular craniopharyngiomas, tuberculum sellae or even planum sphenoidale meningiomas and clival tumors become accessible for removal via an endoscopic approach. The authors review the main alternative surgical techniques of the endoscopic endonasal transsphenoidal approach. They also present the results and the complications of the endoscopic transsphenoidal surgery. Due to an improvement and refinement of the surgical procedures, the endoscopic endonasal transsphenoidal approach can be considered a good choice for the excision of the sellar and parasellar lesions

On negative higher-order Kerr effect and filamentation

As a contribution to the ongoing controversy about the role of higher-order Kerr effect (HOKE) in laser filamentation, we first provide thorough details about the protocol that has been employed to infer the HOKE indices from the experiment. Next, we discuss potential sources of artifact in the experimental measurements of these terms and show that neither the value of the observed birefringence, nor its inversion, nor the intensity at which it is observed, appear to be flawed. Furthermore, we argue that, independently on our values, the principle of including HOKE is straightforward. Due to the different temporal and spectral dynamics, the respective efficiency of defocusing by the plasma and by the HOKE is expected to depend substantially on both incident wavelength and pulse duration. The discussion should therefore focus on defining the conditions where each filamentation regime dominates.Comment: 22 pages, 11 figures. Submitted to Laser physics as proceedings of the Laser Physics 2010 conferenc

Brain abscesses: management and outcome analysis in a series of 84 patients during 12 year period

Authors analyze 84 cases of brain abscesses operated between January 2000 and December 2011, in the Fourth Neurosurgical Department by the same surgical team. We underline the general series profile: the mean age was 42.96 years (range: 11-75 years old), 72.62% were males, association with heart defects in seven cases (8.33%), positive bacteriological examination for germs in only 37 cases (44.04%), all negative for HIV infection. The median number of days to diagnosis was 9. Most frequent clinical presentations included headache (40.47%), fever (35.71%), focal neurologic deficits (29.76%), increased intracranial pressure (28.57%) and seizures (11.90%).The majority of cases (76.19%, n=64) presented a supposed medical condition favoring dissemination of a previous infection: malnutrition, tuberculosis, chronic alcoholism, chronic liver malady, neglected dental or ear infections, and only 5 cases (5.95%) had been diagnosed with secondary immunodeficiency syndromes following autoimmune systemic diseases.According to our treatment policy all cases except for two (treated by puncture and aspiration) benefited of open surgery and total removal of the lesions, without local recurrence. Outcome was favorable in 82.14% (n=69) of subjects. General morbidity was 26.19%, and mortality stood at 7.14%. Six cases remained with permanent motor deficit (7.14%) and four (4.76%) with controllable seizures. Out of a total of 33.33% (n=28) of complications, 64.28% were due to medical causes.Follow-up had been extended up to three years for at least 2/3 of patients, who resolved in time medical or surgical conditions which determined cerebral dissemination of the infection. Despite of a poor medical and biological condition, the patients with brain abscess outside of HIV infections benefit from neurosurgical adequate treatment, and if supportive medical and general therapy is continued and sustained, the healing and survival in good neurological status is the rule. Hematogenous spread and advance age were predictors of poor prognosis. Our findings are similar to the results of recent works, although in our series, there is a higher frequency of aerobe germs

Surgical management of symptomatic spinal cord and intracerebral cavernomas in a multiple cavernomas case

Multiple cavernous malformations are associated with familial cases and are present in 10-20% of all cavernoma cases. 5% of cavernomas are located intramedullary and of these only 10% present multiple cavernomas. With the availability of echo gradient MRI the cases of multiple cavernomas are diagnosed earlier and it is not rare that it uncovers multiple cavernomas in cases where only a single lesion can be identified on regular MRI sequences. We present the case of a 55 years old woman presented with a two years history of mild backache, followed by progressive lower legs motor deficit and urinary retention. The spine MRI showed an intramedullary T2/3 lesion and the cerebral MRI established the diagnosis of multiple cavernomas. One year after the intramedullary cavernoma was operated with success, she developed generalized seizures and a new cerebral MRI showed bleeding and volume growth of one right temporal pole cavernoma. The cerebral lesion was resected successfully and the patient was discharged free of seizures. This familial type multiple cavernomas cases should be screened and followed with repeated brain and spine MRI’s every year

A quantitative theory-versus-experiment comparison for the intense laser dissociation of H2+

A detailed theory-versus-experiment comparison is worked out for H$_2^+$ intense laser dissociation, based on angularly resolved photodissociation spectra recently recorded in H.Figger's group. As opposite to other experimental setups, it is an electric discharge (and not an optical excitation) that prepares the molecular ion, with the advantage for the theoretical approach, to neglect without lost of accuracy, the otherwise important ionization-dissociation competition. Abel transformation relates the dissociation probability starting from a single ro-vibrational state, to the probability of observing a hydrogen atom at a given pixel of the detector plate. Some statistics on initial ro-vibrational distributions, together with a spatial averaging over laser focus area, lead to photofragments kinetic spectra, with well separated peaks attributed to single vibrational levels. An excellent theory-versus-experiment agreement is reached not only for the kinetic spectra, but also for the angular distributions of fragments originating from two different vibrational levels resulting into more or less alignment. Some characteristic features can be interpreted in terms of basic mechanisms such as bond softening or vibrational trapping.Comment: submitted to PRA on 21.05.200

Deontological issues - possible misdiagnosis of cerebral metastases

Authors analyses a number of 4588 (52, 24% over 50 years old) patients operated for cerebral tumors in the Clinic Emergency Hospital “Bagdasar-Arseni” from Bucharest, between 2000-2010, with peculiar attention to the concordance between the preoperative and postoperative diagnosis, related to the actual policy to evaluate a neurosurgical patient before surgery. 903 cases were cerebral metastases and 69,5% aged over 50 years old. In 9,7% of cases we recorded a preoperative misdiagnosis of a metastasis due to few main reasons: unavailable information about a present primitive cancer, treacherous MRI image with a single confusing appearance of a cerebral lesion, age less than 50 years old, clinical presentation and biological evaluation inconsistent with malignancy. Authors point that these situations can have serious consequences related to professional competence, deterioration of the patient-doctor relationship, increasing costs for completion of diagnosis and treatment, and inadequate information about patient’s prognosis