Hydatid cyst excision using Dowling's technique of hydrodissection

BACKGROUND

Neurohydatidosis is a rare zoonotic disease in nonendemic areas and a differential diagnosis of intracerebral cysts workup. Appropriate imaging modalities with serology are required for proper diagnosis. The gold standard surgical intervention is the Dowling-Orlando technique.

METHOD

We provide a detailed description, with key surgical steps, for total excision of hydatid cysts with intact capsules by hydrodissection. We also describe the relevant surgical anatomy, with indications, limitations, and possible complications.

CONCLUSION

Hydrodissection allows safe resection of hydatid cysts without further damage to the surrounding parenchyma and reduces the risk of cystic wall rupture.

["Water Hammer effect": a rare mechanism of hydrocephalus]

We are reporting a case of functional hydrocephalus in a 66-year-old male patient presenting for gait disturbance. The etiology of the disease is a cerebrospinal fluid flow disturbance due to an ectatic basilar artery at the level of Monro foramen. Different pathophysiological mechanisms are discussed below.

[Indications for total hypophysectomy in Cushing's disease]

OBJECTIVE

Transsphenoidal selective adenomectomy is the treatment of choice for Cushing's disease. In some patients, magnetic resonance imaging (MRI) fails to detect small pituitary ACTH-secreting adenomas. Total hypophysectomy can be performed when MRI appears normal. The aim of this paper is to study results and complications after total hypophysectomy for Cushing's disease.

METHODS

Between July 1988 and May 1999, 49 patients underwent transsphenoidal surgery for Cushing's disease at our institution. The criteria for inclusion in this study were clinical and biochemical studies strongly suggestive of Cushing's disease with normal MRI. Total hypophysectomy was performed in 7 patients who fulfilled these criteria. Their results were analyzed retrospectively.

RESULTS

The average age of the patients was 43 years; there were 7 women. Five adrenocorticotrophic hormone-secreting adenomas were proven histologically. Complications occurred in 6 patients (cerebrospinal fluid fistulas in 6 patients, loss of vision in 1 patient, meningitis in 5 patients, anterior pituitary insufficiency in 5 patients, diabetes insipidus in 5 patients). Six patients had sustained remission 36 months after surgery.

CONCLUSION

Total hypophysectomy can be perform ed for Cushing's disease with normal MRI. Complications occurs frequently, especially cerebrospinal fluid fistulas. Inferior petrosal sinus sampling can be helpful in localizing the adenoma allowing hemihypophysectomy and thus reduced morbidity.

[An unusual cause of acute myelopathy: a dural arteriovenous fistula at the craniocervical junction]

BACKGROUND

Dural arteriovenous fistulas (DAVF) account for 10% to 15% of all intracranial arteriovenous malformations. Since the first case published by Woimant et al. in 1982, many type V DAVF, i.e. with spinal venous drainage, have been reported. Fistulas located at the craniocervical junction (CCJ) however, are exceptional and only 10 cases of CCJ fistulas associated with myelopathy have been described.

CASE REPORT

The authors present a 36-year-old male patient without previous medical history, suffering from acute myelopathy. Cervical MRI showed multiple serpiginous flow-voids along the cord surface and cerebral angiography disclosed a dural fistula of the CCJ fed by the right posterior meningeal and occipital arteries. The venous drainage was directed caudally towards the perimedullary veins. Embolization through the occipital artery, using cyanoacrylate, was performed and resulted in complete cure of the malformation with rapid clinical recovery.

DISCUSSION

The authors discuss the pathophysiology and clinical consequences of intracranial DAVF with myelopathy (named V, m+), that are usually identical to those of spinal dural fistulas and related to intramedullary venous hypertension. Early treatment is essential to reverse the patient's myelopathy. Embolization, if technically possible, is the preferred treatment and cyanoacrylate remains the best embolic agent. Following glue deposition, systemic high-dose steroids should be administered to prevent edema.

CONCLUSION

In conclusion, this is the first case of DAVF of the foramen magnum causing myelopathy to be detected early and cured by glue embolization alone, with rapid and total clinical recovery.

[Cervical myelopathy from ossification of the posterior longitudinal vertebral ligament. Report of 2 cases]

BACKGROUND AND PURPOSE

Cervical myelopathy due to an ossification of the posterior longitudinal ligament (OPLL) is a rare entity in western countries but frequent in Japan. We report on two Lebaneese patients aged 67 and 72 years respectively, who were twins and presented with OPLL.

METHODS

Diagnosis was made on myelography in the first case (1989) and on MRI of the cervical spine in the second case (1994).

RESULTS

A wide laminectomy was performed in the first case followed by a marked improvement. In the second case, corporectomy of the third, fourth and fifth vertebra with removal of the ligament followed by bone graft didn't improve the clinical symptoms.

CONCLUSION

The cause of OPLL remains unknown: genetic factors and metabolic abnormalities are outlined. Treatment options are discussed.

[Value of increased MRI signal intensity in cervical arthrosis in myelopathies]

The case of 52 patients with cervical myelopathy were reviewed to determine whether a high signal intensity lesion present on T2 weighted spin echo imaging appears to be an important indicator for predicting prognosis. Preoperatively, there were areas of increased signal intensity in 23 patients. The lesion was clearly demonstrated on T1 weighted images in only one case. Postoperatively, MRI was performed in 9 cases, one showed decreased signal intensity compared to the preoperative levels, and 8 had no change. The pre and postoperative clinical conditions of the patients whose preoperative MR images showed areas of increase signal intensity were not worse than those patients who did not have these areas of increased signal intensity. The postoperative recovery of the eight patients who exhibited no change of the signal intensity was very satisfactory. The pathophysiology of such an abnormality is presumed to be related to edema, myelomalacia or gliosis. However, the presence of these areas of high signal intensity does not appear to be an indicator of a bad clinical prognosis.

[Cerebral metastasis disclosing osteosarcoma. Apropos of a case]

Brain metastasis from osteosarcoma is a rare entity. Almost 20 cases have been reported in the literature. We report an illustrative case of a 15 years old boy presenting with isolated brain metastase revealing a fibular osteosarcoma. Diagnostic methods and treatment modalities are discussed.

[Stereotaxic approach in deep cerebral lesions]

The authors report a retrospective study (April 92-April 95) of 60 CT guided stereotactic biopsies. The procedure offered accurate histological diagnosis in 56 cases. There were 38 glial tumors, the majority being of high grade (III-IV). Five abscesses were evacuated and medically treated. Complications occurred in 5% of cases. These results are compatible with those reported in the literature. The simplicity and accuracy of stereotactic procedure are confirmed, making it an imperative step in the management of intraxial space occupying lesion when surgical resection is negotiable. The other applications of the stereotactic procedure are exposed.

[Cervical extradural hematoma under coagulants. Review of etiologies and prognosis]

We report a case of cervical epidural hematoma associated with anticoagulant therapy in a 68 year-old man, who presented with tetraplegia. He was operated 12 hours after the onset. Three months later, he had recovered almost completely. The etiologies and prognosis of such lesions are reviewed.

[Thermocoagulation in the treatment of facial neuralgia. Preliminary results in 22 cases]

Twenty-two patients suffering from trigeminal neuralgia were treated by thermocoagulation from June 92 to June 94 at Hôtel-Dieu de France Hospital. Epidemiological, clinical, para-clinical elements and the therapeutic approach were studied. The results after a median follow-up of one year were satisfactory in twenty patients (90.9%) who became asymptomatic. No major complication was noticed. Two recurrences occurred however, one responded to another thermolesion. We propose and discuss this technic for the treatment of the trigeminal neuralgia.

Prescribing Exercise: More Than Just a Running Program

New concepts of fitness and an increasing awareness of the social aspects of exercise will stimulate physicians to recommend programs that improve all four components of fitness.

Primary Care Physicians: First Stop for Exercise Advice?

Patients are urged to consult a physician before starting an exercise program, but how many do and what advice do they receive?

Perceived Exertion: One Measure of Exercise Intensity

Gunnar Borg developed the rating of perceived exertion to measure long-term changes in work capacity. Now it is used to monitor exercise programs for at-risk individuals and cardiac patients.

Strength: One Component of a Winning Team

The University of Nebraska strength development program features year-round training, free weights, and computerized strength records and has become the model for others in the country.

Salina Family Clinic Finds New Role for Exercise Physiologist

In Salina, Kansas, an agricultural community of 40,000, an exercise Physiologist complements the family physician's responsibility in developing wellness programs by conducting stress tests, preparing exercise prescriptions, and counseling patients.

Medical Care for Athletes: What Is the Coach's Role?

The ability of high school coaches to provide medical care for athletic Injuries is under Increased scrutiny. Several states require that coaches be certified in emergency techniques, but most don't.

Physician Skis for Fitness, Races for Reward

Milton Hanson was looking forward to a five-month cross-country skiing vacation, but the challenge of ski racing induced him to enter a series of international races.

Cheerleading: New Problems in a Changing Sport

High school and college cheerleading is becoming more sophisticated and competitive, yet research on injuries and conditioning is virtually nonexistent. Liability problems may produce additional changes.

Education in Sportsmedicine: Coming Into Its Own

Sportsmedicine rotations included in residency programs in medical schools and schools of osteopathy reflect the public's demand for more complete medical information.

Exercise Employees: Changing Standards in a Changing Industry

Fitness employees have different levels of education and training. Are they qualified to give exercise advice?