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  • 1
    ISSN: 0942-0940
    Keywords: Medulloblastoma ; chemotherapy ; supratentorial metastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Forty-seven children with histologically confirmed medulloblastoma are considered. Forty-five cases were surgically treated by direct approach to the tumour, while two cases were treated only with a shunt. A shunt was inserted preoperatively in 14 cases, postoperatively in 4 cases. Surgical resection was total or subtotal in 52% of cases, partial in 35%, and limited to a biopsy in 13%. Radiation treatment to the entire neuraxis was done in 37 cases: 10 of these cases received additional chemotherapy—mostly with CCNU—as primary treatment for medulloblastoma. Ten patients died within 30 days after surgery. Twenty-two patients died months after treatment, mainly from tumour recurrence (19 cases). One patient was lost to follow-up. Thirteen patients are survivors from 10 months to 20 years after treatment. As a whole, the one year survival rate has been 67%, 3 year survival 43%, and 5 year survival 27%. Complications affecting prognosis have been presented by tumour recurrence and metastases. CSF shunting and lack of prophylactic irradiation to the cerebral hemispheres have been considered responsible for the high incidence of supratentorial metastases in our series. Factors influencing prognosis have been the extent of tumour resection and association of primary chemotherapy with radiotherapy. Within 3 years after surgery survival has been 52% in cases with total resection against 31% in cases with partial resection of tumour. As regards chemotherapy, 3 year survival has been 60% for patients with combined treatment (chemo- and radiotherapy) against 37% in patients with radiotherapy alone. It is concluded that the best results in children with medulloblastoma are achieved by a radical resection, associated with a combined primary treatment of radiotherapy and chemotherapy.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0942-0940
    Keywords: Cerebral aneurysms ; antifibrinolytic therapy ; cerebral ischaemia ; hydrocephalus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 350 patients with subarachnoid haemorrhage from aneurysmal rupture—admitted in the years 1966–1983—were selected for a retrospective controlled study on the efficacy of antifibrinolytic therapy (AFT). Patients treated with antifibrinolytics were divided into two groups, according to the day of hospital admission and onset of therapy, respectively between 0 and 3 days (SG 1) and between 4 and 7 days from SAH (SG2); treated patients (260 cases) received i.v. tranexamic acid (6gr/day) for at least two weeks. Patients admitted before 1974, not receiving antifibrinolytics (90 cases), were selected as controls and divided into two groups (CG 1 and CG 2), according to the day of admission. In the first study group (admission 0–3 days) the rebleeding rate within 2 weeks was 9% versus 23% in controls (p〈0.01). The incidence of rebleeding within 3 and 4 weeks was also significantly lower (p〈0.05) than in controls. No significant difference was observed in the rebleeding rate in treated and untreated patients with late admission (4–7 days). Mortality from rebleeding was 16% in the first study group versus 17% in controls; in the second study group the figure was 6% versus 8% in controls. Seventy-five cases of ischaemic disorders (29%) were registered in treated patients versus 13 cases in controls (14%; p 〈 0.01). Thirty-seven patients receiving AFT (14%) developed significant ventricular dilatation requiring shunt insertion, versus one patient in the control groups (1%; p〈0.001). Final outcome was similar in the 4 groups. In conclusion—according to our data—AFT modifies the behaviour of rebleeding and the patients' course, although it does not modify the outcome after SAH. Clinical use of antifibrinolytic therapy appears still justified in those patients who cannot be operated on in the acute stage after SAH, provided that an associated anti-ischaemic therapy is undertaken.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 97 (1989), S. 1-16 
    ISSN: 0942-0940
    Keywords: Epidermoid ; dermoid ; extradural ; intradural
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We review 40 epidermoids and 4 dermoids of the skull and brain treated surgically in our Department between 1976 and 1987. Fourteen were extradural and 30 intradural. The mean duration of symptoms was 3 years for extradural and 10 years for intradural tumours. Symptoms varied with tumour site, in some sites being helpful in differential diagnosis. Skull X-rays and CT were the key diagnostic investigations in extradural and CT in intradural lesions, the latter, with few exceptions, presenting a characteristic CT scan. In 7 cases MRI supplied important details on the tumour boundaries. All the diploic and orbital lesions were removed totally, with a good outcome. Twelve of the intradural lesions were removed totally, 9 subtotally and 9 partially, with a good outcome in 21 patients and a poor outcome in 4; 5 patients died. Outcome was unrelated to degree of removal.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 97 (1989), S. 31-39 
    ISSN: 0942-0940
    Keywords: Subarachnoid haemorrhage ; negative panangiography ; CT scan ; vasospasm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 65 patients with negative but technically satisfactory 4 vessel angiography —all admitted to our Department in the years 1976–1983 — were evaluated in the present study. CT scan was undertaken in all cases (in 47 cases within 4 days of haemorrhage). Arterial hypertension was present on admission in 9% of cases. The period of follow-up ranged from 4 to 11 years, with a mean of 5,3 years. The study group was compared to a control group, comprising 760 patients with subarachnoid haemorrhage from ruptured aneurysms, admitted during the same period. Clinical grade on admission (Hunt's classification) was better in patients belonging to the study group. The amount of cisternal deposition on CT scan was less significant than in patients with ruptured aneurysms, and the deposition was often atypical (circumpeduncular, ambiental, and/or tentorial). Clinical deterioration associated with vasospasm was observed in 5% of patients in this study and in 27% of patients in the control group. In patients with a consistent or thick cisternal layer (CT scan “at risk”) the incidence of clinical vasospasm was 21%, against 47% in controls. One or more rebleedings occurred in 12% of patients in the study group, against 25% of patients in the control group. A significant ventricular dilatation was observed in 15% of patients in the first group (requiring a shunt in 8%), against 25% of patients in the second group (requiring a shunt in 11%). Final outcome was favourable in 95% of patients in this study group and in 63% of patients in the control group, with a mortality rate of 5% in the first group and 32% in the second group.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 64 (1982), S. 259-271 
    ISSN: 0942-0940
    Keywords: Midline AVMs ; cardiac failure ; hydrocephalus ; brain atrophy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Three rare cases of giant midline arterio-venous malformations are presented. The first case is an infant girl with a vein of Galen malformation, who died from a subarachnoid haemorrhage a few weeks after shunt insertion for the control of hydrocephalus. The second case is an infant girl with a massive dilatation of the superior longitudinal sinus, who died from acute cardiac decompensation following direct surgery on the malformation. The third case is an infant boy with very large bilateral angiomas of the basal ganglia, who was not treated surgically. Some unusual features of these cases are discussed. Anatomically, the lesion can be quite different from a typical vein of Galen malformation. Clinically, the presence of cardiac failure and hydrocephalus is not always the case, and the possibility of a subarachnoid haemorrhage must be considered. For these reasons, infants with giant midline AVMs should be treated individually, balancing various considerations.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 65 (1982), S. 67-80 
    ISSN: 0942-0940
    Keywords: Paediatric head injury ; extradural haematoma ; frontal extradural haematoma ; CT scan in traumatology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Sixty-two children with traumatic extradural haematomas are considered. According to the clinical history presented—often atypical— and to the grade of neurological impairment, patients have been divided into different clinical groups. Nearly 50% of patients sustained a minor injury, and 26% did not lose consciousness after trauma. Twenty-four per cent of patients did not show fractures on skull X-rays. Atypical location of the haematoma was noted in 22 cases, mainly in the anterior fossa (19 cases). Sixty patients were operated on, while two patients were conservatively treated, owing to the limited size of the haematomas and to the absence of neurological deficits. Associated brain lesions were discovered at surgery in 40% of cases. The overall mortality rate has been 17%, the operative mortality rate 14%. The morbidity rate has been 6%, with 3% of patients presenting severe disability. Morbidity and mortality have been shown to be affected by age—with better prognosis in patients under 10 years of age, by the clinical history presented, by the preoperative conditions, and, mainly, by the presence of associated brain lesions. As regards location, frontal haematomas have shown a better prognosis and a slower course than convexity haematomas. Finally, prognosis of extradural haematomas in children has improved to some extent in the last years with the advent of the CT scan, possibly due to speed and accuracy of diagnosis.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Keywords: Glioma ; pituitary adenoma ; arterio-venous malformation ; surgical treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 3 cases of primary cerebral tumours associated to intracranial arterio-venous malformations are reported. The presenting symptoms were caused by the AVM in 2 patients, by the tumour in 1 patient. In 2 cases the lesions were coexistent, while in one case the tumour was diagnosed 30 months after resection of the AVM. The tumour was a glioma in 2 cases, a pituitary adenoma in 1 case. The AVM was located in the right hemisphere in 2 patients, and was always ipsilateral to the tumour. Surgical treatment was undertaken in all patients, and consisted of resection of the tumour and AVM in 2 cases, and only resection of the tumour in 1 case. As regards outcome, one patient survived with a mild deficit, and 2 patients died from the natural evolution of the malignant tumour. It is concluded that the management of associated AVMs and brain tumours should be decided in the individual patient according to various considerations, owing to the variability of each lesion and to the relatively benign prognosis of an arterio-venous malformation.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 82 (1986), S. 28-38 
    ISSN: 0942-0940
    Keywords: Primary brain tumours ; ruptured aneurysms ; incidental aneurysms ; surgical treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 18 patients harbouring a primary cerebral tumour associated with one or more intracranial aneurysms are presented. Initial symptoms were caused in 10 cases by the tumour, in 8 cases by aneurysmal rupture. In 2 cases the tumour was discovered years after the exclusion of the aneurysm. The tumour was supratentorial in 14 cases, and was more commonly a meningioma (44% of cases) or glioma (38% of cases). A total of 25 aneurysms were observed in the 18 patients: 8 had ruptured and 17 were incidental. The aneurysms were more commonly on the internal carotidartery (40%). Surgical treatment was undertaken in 13 patients, and consisted of: a) tumour resection plus aneurysmal exclusion in 6 patients, b) only tumour resection in 5 patients with incidental aneurysms, and c) only exclusion of the aneurysm in 2 patients later developing malignant gliomas. Rupture of incidental aneurysms was never observed. The prognosis was linked mainly to the nature of the tumour in cases with malignant tumours, and to the evolution of subarachnoid haemorrhage in patients with ruptured aneurysms. As a whole, a satisfactory recovery was observed in 7 patients, and death occurred in 11 patients, mainly due to progressive evolution of the malignant tumour (in 6 cases) or to fatal aneurysmal rebleeding (in 3 cases). It is concluded that tumours associated with aneurysms should be operated on at the same time whenever possible, and decisions regarding exclusion of incidental aneurysms should be balanced against the risks of the procedure.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0942-0940
    Keywords: Substance P ; vasospasm ; subarachnoid haemorrhage ; isometric tension recording ; cyclic GMP ; rabbit
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The vasoactive effects of substance P (SP), as well as the content of cyclic guanine monophosphate (cGMP), were determined in the rabbit basilar artery after subarachnoid haemorrhage (SAH). Out of 47 rabbits, 24 were subjected to a SAH, induced by injecting 5ml of autologous arterial blood into the cisterna magna; 23 were used as controls. In 20 animals (10 SAH and 10 controls), isometric tension recording of isolated rings of the basilar artery — dissected 2 days after SAH — was employed to assess the dosedependent vasodilatation to SP (10−10 to 10−6M) after precontraction with serotonin (10−8 to 10−5M). In 15 animals (8 SAH and 7 controls), the basal cGMP content was measured in the basilar artery 2 days after SAH. In the other 12 animals (6 SAH and 6 controls), the increase in cGMP content was measured in the basilar artery after a 10-minute incubation with SP (10−6M). SP caused significantly less dilatation in animals subjected to SAH than in controls, especially for concentrations between 10−9 and 10−6M (p 〈 0.001). The cGMP content in the arteries 2 days after SAH was significantly lower than in control arteries (31.5 ± 7.3 against 57.3 ± 4.3 pmoles/g tissue). In the preparations incubated with SP, the increase of cGMP was 440 ± 115% in the control arteries, and only 97 ± 30% in the arteries after SAH. It is concluded that the vasodilator activity of SP is significantly impaired after SAH. Moreover, the changes in cGMP content after SAH suggest a link between impaired vasoactive response to SP and decreased production of cGMP after SAH.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 63 (1982), S. 153-159 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 41 patients with ruptured intracranial aneurysms were all submitted to an early operation, (within 3 days from SAH), and evaluated with regard to the results of treatment. In this group, vasospasm has influenced the outcome more than other causes, accounting for 58% of morbidity and 64% of mortality. On the basis of our experience with 380 patients suffering from SAH and all submitted to a CT scan, the presence of consistent intracisternal blood in the CT scan at admission has shown to be the main risk factor resulting in vasospasm. Therefore, the group with early surgery has been compared, on the basis of the CT scan picture, to a group of 76 patients in which surgery had been delayed at least 10 days after SAH. Whilst the incidence of vasospasm has been very similar in the groups compared, the incidence of neurological deterioration brought about by spasm has been higher in patients waiting for surgery (55%, against 36% in the group with early surgery). Avoidance of clinical deterioration has not been always possible with early surgery, even after careful cleansing of the cisterns from clots, as was shown by 2 of our cases. It is concluded that vasospasm does not seem to influence the outcome of early surgery to a greater extent than it would during the natural course of subarachnoid haemorrhage.
    Type of Medium: Electronic Resource
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