We investigated the sensitivity and specificity of [(11)C]-methionine positron emission tomography ([(11)C]-MET PET) in the management of glioma patients. We retrospectively analysed data from 53 patients with primary gliomas (16 low grade astrocytomas, 15 anaplastic astrocytomas and 22 glioblastomas) and Karnofsky Performance Status (KPS) > 70. Patients underwent [(11)C]-MET PET scans (N = 249) and parallel contrast-enhanced MRI (N = 193) and/or CT (N = 113) controls.
View Article and Find Full Text PDFO(6)-alkylguanine-DNA alkyltransferase (AGAT), involved in temozolomide-induced DNA damage repair, plays a key role in the efficacy of temozolomide. AGAT activity may be reduced by protracted temozolomide doses. On the basis of the preclinical findings, we treated patients with a histologically-proven diagnosis of glioblastoma (GBM) following adjuvant temozolomide failure with a low protracted dose of temozolomide (130 mg/m(2)/day, days 1-7 and 15-21, every 4 weeks).
View Article and Find Full Text PDFWe explored the efficacy and safety of bilateral SubThalamic Nucleus (STN) stimulation in two subjects suffering from drug-resistant epilepsy even after anterior callosotomy. Case 1 had about 65% decrease of partial motor seizures and the complete disappearance of tonic-clonic generalized attacks. Case 2, with sudden drop (atonic) attacks, partial complex seizures, atypical absences and rare tonic-clonic seizures, showed no meaningful reduction of fits and a stimulation associated atypical absence rate increase.
View Article and Find Full Text PDFPurpose: The effectiveness of VNS was evaluated in thirty-nine encephalopatic patients with drug-resistant epilepsy characterized by multiple seizures and drop attacks. Twenty-five patients were affected by severe epilepsy with multiple independent spike foci (SE-MISF) and fourteen patients by Lennox-Gastaut syndrome (LGS).
Method: Changes in seizure frequency, cognition, adaptive behaviour and quality of life were assessed before and after VNS implant until three years.
Purpose: The aim of the study was to compare the outcome with respect to age of implant, aetiology and duration of epilepsy.
Methods: One hundred thirty-five drug-resistant epileptic patients, excluded from ablative surgery, were submitted to vagal nerve stimulation (1995-2007). Aetiology was cryptogenic in 57 and symptomatic in 78 patients.
Introduction: Anterior cingulate epilepsy is a peculiar epileptic syndrome with a broad range of clinical manifestations, depending on the numerous projections of anterior cingulate into motor systems. Its diagnosis is often delayed, as seizures mostly occur during sleep and are typically misdiagnosed as parasomnias. Moreover, most focal anterior cingulate epilepsies are believed to be cryptogenic or idiopathic, even if there are some reports of anterior cingulate cortical dysplasia, while anterior cingulate neoplasms underlying epilepsy are rare.
View Article and Find Full Text PDFBackground: Meningoencephalitis may sometimes cause medically refractory intracranial hypertension and brain herniation. In such patients death is common. There are a limited number of reports on the use of decompressive craniectomy as a life saving measure in these circumstances with some good results.
View Article and Find Full Text PDFThe objective of this study is to evaluate the safety and efficacy of vagus nerve stimulation (VNS) in very young children suffering from catastrophic epilepsy and status epilepticus. We reviewed files of 60 VNS-implanted children at our institution and we selected six very young patients, less than 3 years old (mean age at implant 1.6 years).
View Article and Find Full Text PDFIntroduction: Vagus nerve stimulation (VNS) is an effective alternative treatment for patients with partial refractory epilepsy. Nevertheless, information regarding VNS in children is still limited.
Materials And Methods: The clinical efficacy, safety and neuropsychological effects of VNS in 34 children (mean age 11.
Vagal nerve stimulation (VNS) is a surgical option to treat drug-resistant epilepsy. A few side effects have been described, mainly as anecdotal reports. We analysed our material concerning a juvenile population to identify the most common and most important complications, discussing them with the literature.
View Article and Find Full Text PDFThe role of antibiotic prophylaxis in preventing postoperative lumbar spondylodiscitis is still controversial in medical, ethical, economic, and legal terms. The aim of this retrospective study was to evaluate the efficacy of two intraoperative antibiotic prophylaxis protocols in a large series of lumbar microdiscectomies performed in two different neurosurgical centres. We reviewed the outcome of 1167 patients operated on for a lumbar disc herniation with microsurgical technique, in order to detect the incidence of postoperative spondylodiscitis.
View Article and Find Full Text PDFIntroduction: The bobble head doll syndrome, mainly affecting children under 10 years of age, is a rare and surgically treatable movement disorder characterized by head bobbing occurring at a rate of 2-3 times/s. Its pathophysiological mechanism is not well known but two main factors are commonly associated with the condition: a dilatation of the third ventricle and, more frequently, a cystic lesion rather than a solid mass in the region of the third ventricle.
Illustrative Case: The illustrative case concerns a child with a third ventricular cystic lesion and hydrocephalus who had experienced abnormal head movements since the age of 1 year as well as ataxia and tremor of the arms.
A rare case of brain abscess due to Gemella morbillorum, a normal inhabitant of the oral cavity, is presented. The aim of this report is to draw the attention of radiology literature readers to this little known pathogen, which caused a potentially life-threatening condition in an immunocompetent young man, and to emphasise the usefulness of a combined stereotactic, medical, and imaging approach to deep-located brain abscesses.
View Article and Find Full Text PDFA 14-year-old girl who presented with a severe sensory-motor-sphincter syndrome was found to be harboring an epidural tumor situated posteriorly in the spinal canal from C5 through C7 levels. The mass had computerized tomography and magnetic resonance imaging features suggesting an unusual stratified architecture, with a conspicuous highly calcific component firmly adherent to the dura and a non-calcific mass surrounding it posteriorly and laterally. Although meningiomas have a low incidence in the first two decades of life, and in the spine they rarely have entirely extradural location at any age, a meningioma was suspected.
View Article and Find Full Text PDFObject: Vagal nerve stimulation (VNS) has recently been proposed as a valid treatment for adult patients with drug-resistant partial epilepsy. Little experience in children has been reported. In order to evaluate the clinical efficacy and tolerance of VNS, we studied 13 paediatric patients with drug-resistant partial epilepsy.
View Article and Find Full Text PDFAJNR Am J Neuroradiol
October 2001
Vertex epidural hematomas (VEDHs) are well known but uncommon. Their clinical presentation may be misleading and missed by routine CT axial scanning; thus, diagnosis may be delayed, with possibly fatal consequences. We report a case of acute posttraumatic paraplegia caused by a VEDH, which was evident at CT and for which the patient underwent successful surgery.
View Article and Find Full Text PDFMultiple glioma is a well-recognized but uncommon entity. They are grouped in two categories: multifocal and multicentric gliomas. Multifocal gliomas grow through dissemination along an established route, spreading through commissural pathways, CSF channels, or the blood or by local extension through satellite formation; at the opposite end of the spectrum, multicentric gliomas are widely separated lesions whose simultaneous presence cannot be attributed to any of the above pathways.
View Article and Find Full Text PDFBackground: The incidence of tuberculous spondylitis, which had declined steadily for over 40 years in our countries, started increasing again in the eighties, paralleling the resurgence of pulmonary tuberculosis. Therefore it has become a matter of discussion in contemporary literature, because it can be a diagnostic challenge and, in spite of its severe neurological complications, it is a potentially curable illness.
Methods: In this retrospective study the authors report their experience concerning 12 patients operated on in a 25-year period because of serious cord compression from thoracic (9 cases) and cervical (1 case) tuberculous spondylitis or from thoracic tubercular epidural lesion (2 cases).
The aim of this study is to describe the authors' experience with intra-arterial ACNU chemotherapy of malignant gliomas. The prognosis of cerebral malignant gliomas remains poor, whatever traditional therapy is applied. ACNU is a well tolerated nitrosourea with a strong antimitotic effect on neurogenic cells both in vitro and in vivo; this drug has enhanced efficacy when used at high concentrations, particularly as an intraarterial infusion.
View Article and Find Full Text PDFThirty-six drug-resistant epileptic patients submitted to callosotomy were studied. Anterior callosotomy was performed in 27 patients, total two-stage callosotomy was performed in 8 patients and 1 patient had only posterior callosotomy. We found mutism in 10 patients (2 after complete callosotomy and 8 after anterior section).
View Article and Find Full Text PDFIn 36 patients with drug-resistant epilepsy submitted to anterior callosotomy (27 cases), to two-stage total callosotomy (8 cases) and to posterior callosotomy (1 case) the EEG variations concerning background activity, focal activity and sharp-waves (SW) bisynchronous activity were evaluated. EEG modifications observed after callosotomy are the following: background rhythm tends to be better organised as spectral analysis demonstrated, this finding usually coincide with reduction of bisynchronous discharges. It appears that improvement in background activity cannot be correlated with outcome, but it seems to be to some extent since at the same time cognitive functions also seem to improve; however, this last aspect need to be checked in much larger series.
View Article and Find Full Text PDFThe callosotomy on drug-resistant epileptic seizures may abolish or reduce their frequency and may modified the morphology of different kind of seizures. Our series is composed of 36 patients. Drop-attacks and complex partial seizures (CP) were present in all patients, generalized tonic-clonic seizures (GTC) in 16 (44.
View Article and Find Full Text PDFSome possible factors to predict outcome after callosotomy were investigated in a personal series composed of 36 patients. Twenty-seven of them were submitted to anterior callosotomy, 1 to posterior callosotomy and the remaining 8 patients to two stage complete division of corpus callosum. All factors, either positive or negative, do not appear completely reliable; they can be envisaged only in relative terms and do not seem to be relevant to make surgical decision or to discard surgery.
View Article and Find Full Text PDFA case of Hodgkin's disease with isolated cerebral relapse is reported here. The peculiar presentation features are reported and the difficulties related to the differential diagnosis are discussed.
View Article and Find Full Text PDF