Peripheral nerve hemangioblastoma

Capillary hemangioblastoma (HB) is a benign, highly vascular tumor limited almost exclusively to the central nervous system (CNS). It occurs primarily in the posterior fossa and less often in the spinal cord. We report three cases of HB occurring in peripheral nerve, two intradural tumors arising in a C4 and a cauda equina nerve root, respectively, and a third lesion in the sciatic nerve at mid thigh. The patients, 1 woman and 2 men, ranged in age from 25 to 49 years. Two had von Hippel-Lindau disease, an association usually found in one-third of CNS HBs, and one had a family history of pheochromocytoma. In every way, HBs of peripheral nerve were indistinguishable from their CNS counterpart. Ranging in size from 1.5 to 5.5 cm in diameter, the tumors were well circumscribed and contained a myriad of small caliber vessels lined by endothelial cells and surrounded by pericytes. Throughout, the lesions were rich in large, often vacuolated stromal cells. In all of the cases, these stained strongly for vimentin and neuron-specific enolase; only one showed focal S100 protein reactivity. Surgical therapy required excision of the affected nerve roots in the first two cases. In the third case, prominent extension of the tumor within epineurium permitted a microsurgical resection with sparing of sciatic nerve fascicles. No tumor recurred during a follow-up period of 5 to 20 months.

Displaced fracture in a hemangiomatous odontoid

Vertebral hemangioma is a common and usually benign lesion encountered on routine radiographic studies. We report the unusual case of a woman who sustained a displaced fracture of a hemangiomatous odontoid after minimal trauma. Good healing was accomplished with external halo bracing alone.

Cerebral arteriovenous malformation in three successive generations

We report a kindred with cerebral arteriovenous malformations in three generations, suggesting autosomal dominant inheritance in this family. Screening asymptomatic persons with a family history for cerebral arteriovenous malformations is discussed.

Cerebrospinal fluid shunt valve fracture with separation: report of three cases

Three cases of shunt valve fracture with separation are reported. Fracture with separation of the shunt valve of a cerebrospinal fluid shunt is an infrequent occurrence. Because a portion of the shunt valve is radiolucent on a shunt survey radiograph, this problem is easily overlooked if it occurs. The diagnosis can be made by comparing old and new shunt survey radiographs and noting the increased distance between radiopaque portions of the shunt on the new x-ray films.

Fractures of the peritoneal catheter of cerebrospinal fluid shunts

A retrospective study of fractures of peritoneal catheters of ventriculoperitoneal shunts is described. Fracture of the peritoneal catheter accounts for 21.2% of shunt revisions. During the time period of January 1985 through July 1993, 401 PS Medical peritoneal catheters were installed and 23 fractures occurred. The fracture rate of PS Medical small-sized catheters is 15.3%. The fracture rate of PS Medical regular-sized catheters is 2.1%. The overall survival rates of the PS Medical small-sized and regular-sized catheters are significantly statistically different (p < 0.001). The peritoneal catheters fractured most frequently in the neck.

Magnetic resonance angiography in the diagnosis of traumatic vertebrobasilar complications: a report of two cases

Although conventional arteriography is usually performed to study the vertebrobasilar system, we report two cases of traumatic vertebrobasilar vascular occlusion that were diagnosed by magnetic resonance angiography. This enabled us to promptly treat the patients. Our experience suggests that magnetic resonance angiography may be a useful diagnostic tool in the setting of acute vertebrobasilar complications, associated with cervical spine trauma.

Cerebrospinal fluid shunt infections by unencapsulated Haemophilus influenzae

Three cases of cerebrospinal fluid (CSF) shunt infection by unencapsulated Haemophilus influenzae are presented. In all, 22 cases of H. influenzae CSF shunt infections have previously been reported. In contrast to these cases, the current three patients showed acute involvement of the peritoneal end of the shunt with unencapsulated H. influenzae. Medical therapy without shunt removal is successful in eliminating H. influenzae type b shunt infection associated with meningitis. However, significant involvement of the peritoneal portion of the catheter by unencapsulated H. influenzae is an indication for removal of the distal portion of the catheter along with appropriate antibiotic therapy.

A case report of Forestier's disease

Radiologic studies are essential in diagnosing Forestier's disease and include lateral cervical spine roentgenograms, thoracic and lumbosacral vertebrae roentgenograms, esophagram, vertebrae roentgenograms, esophagram, and computed tomography. Patients with Forestier's disease may be considered to be operative candidates if they have persistent dysphagia, dysphonia, and a feeling of fullness or foreign body in the throat. The patient in our case report underwent anterior surgical resection of her anterior cervical osteophytes. Two months following surgery, she was no longer experiencing dysphagia or dyspnea.

Rectal sphincter pressure monitoring device

A silicone, dual cuffed catheter designed for the control of nasal hemorrhage was used for rectal sphincter pressure monitoring. Patients with lipomyelomeningocele and tethered spinal cord were monitored during their operative procedures to aid in distinguishing sacral nerve roots from other tissues. Stimulation of sacral nerve roots was done with a disposable nerve stimulator. The use of a catheter with two balloons helps to keep the outer balloon placed against the rectal sphincter.

Surgical relief of progressive upper limb paralysis in Arnold-Chiari malformation

Two cases of delayed progressive paralysis of the upper limbs in an adult and a teenage patient, without neurological deficits in other regions of the body, are presented. In both cases, the pathology appeared to be a traction lesion of the middle cervical and lower cervical nerve roots, due to abnormal angulation of the nerve roots, which first ran up and then downward in the neural foramina and canal. Re-routing of the nerve roots by removing part of the floor of the neural canal, or by a facetectomy, appeared to offer extensive improvement or full recovery.

Growing skull fractures

Four cases of growing skull fracture in children are presented and the reasons for poor surgical results are analyzed. The clinical presentation, causative factors, and operative findings are discussed.