Update: Chiari Type 1

In a series of 71 patients, pain was the commonest symptom (69% of patients); other symptoms included weakness (56%), numbness (52%), and unsteadiness (40%). The presenting physical signs consisted of a foramen magnum compression syndrome (22%), central cord syndrome (65%), or a cerebellar syndrome (11%). Myelography was performed in 69 patients, and was the most useful investigation. Only 23% of plain radiographs were abnormal. In addition to tonsillar descent, the operative findings included arachnoid adhesions (41%) and syringomyelia (32%). All patients underwent suboccipital craniectomy and C1-3 laminectomy. Respiratory depression was the most frequent postoperative complication (14%), and one patient died from sleep apnea. Early postoperative improvement of both symptoms (82%) and signs (70%) was followed by later relapse in 21% of patients, showing an initial benefit following surgery. None of the patients with a cerebellar syndrome deteriorated, whereas 56% of patients with evidence of foramen magnum compression and 66% of those with a central cord syndrome maintained their initial improvement. The authors conclude that posterior fossa decompression appears to benefit some patients, although a significant proportion might be expected to relapse within 2 to 3 years after operation, depending upon the presenting syndrome 1)

1) Paul KS, Lye RH, Strang FA, Dutton J. Arnold-Chiari malformation. Review of 71 cases. J Neurosurg. 1983 Feb;58(2):183-7. PubMed PMID: 6848674.

Taylor-Haughton line revisited

Taylor Haughton line

In 1900 Taylor and Haughton described a technique to define a line on the scalp directly above the central fissure 1)

1. Draw a Nasion-Inion line ( Nasion – Just below Glabella and Inion -External Occipital protruberance)

2. Divide the Nasion-Inion line in to 25%, 50% and 75%

3. Bregma is the point between the 25% and 50% points and Lambda is at 75% point

4. Sylvian fissure is drawn from the orbitotemporal angle (A point of depressin where eyebrow ends) to the 75% point on naso-inion line.

5. Draw a line perpendicular to the root of the zygoma starting at preauricular point

6. Central sulcus is drawn from 54% point on naso-inion line to the point where the sylvian line cuts the perpendicular line

The Taylor-Haughton line was used to identify the central fissure in computed tomography (CT) images. Radiopaque catheters are placed on the scalp on either side of the Taylor-Haughton line prior to CT imaging. The accuracy of the Taylor-Haughton line for identifying the central fissure was also investigated in cadaver brains. The Taylor-Haughton line provides a good approximation of the location of the rolandic fissure 2)

1) Taylor EH,Haughton WS.Some recent researchers on the topography of the convolutions andfissures of thebrain.Trans R Acad Med Ireland 1900;18:511-522
2) Taylor AJ, Haughton VM, Syvertsen A, Ho KC. Taylor-Haughton line revisited. AJNR Am J Neuroradiol. 1980 Jan-Feb;1(1):55-6. PubMed PMID: 6779590.

Murió el neurocirujano Sixto Obrador Alcalde

El doctor Sixto Obrador Alcalde, pionero de la neurocirugía española, falleció , a los 66 años de edad, a consecuencia de un cáncer de páncreas. El doctor Obrador había sido ingresado el martes en el centro de especialidades médicas Ramón y Cajal, cuyo departamento de neurocirugía puso en funcionamiento, y fue asistido en todo momento por el doctor internista Manuel Serrano Ríos.

El doctor Obrador era partidario de una investigación coordinada para lo que pretendía contar con la colaboración directa de neurofisiólogos, neuropatólogos, neuroquímicos, neurólogos, psiquiatras, psicólogos y neuroanestesistas entre otros especialistas médicos.

El lema del neurocirujano fallecido era que todo enfermo del sistema nervioso debe tener en España una buena asistencia neurológica y neuroquirúrgica especializada. Pese a que el aproximadamente centenar de neurocirujanos españoles son discípulos suyos, el doctor Obrador había dicho: «Siempre es necesario tener presente en nuestra labor la humildad e insignificancia de la propia obra. Apenas representa un corto y efímero eslabón de contacto entre pasadas y futuras generaciones. Estamos obligados a crear en todo momento el clima y el ambiente adecuados para el desarrollo futuro de nuestras disciplinas. Por esta razón he consumido mucho tiempo en la enseñanza y divulgación para los médicos.»

Más sobre Sixto Obrador Alcalde

Tumors of the cerebellopontile angle; considerations on 10 cases

Cerebellopontine angle tumor

Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors.

Types

The most common CPA lesions are vestibular schwannomas (70-80%), meningiomas (10-15%) and epidermoid cysts (5%). CPA tumors are estimated to be the secondary cause for up to 9.9% patients with trigeminal neuralgia.

see Vestibular schwannoma

Cerebellopontine angle meningioma

Cerebellar astrocytoma

Cerebellopontine angle epidermoid cyst

Glomus jugulare associated with the glossopharyngeal nerve

Metastases

Cerebellopontine angle atypical teratoid rhabdoid tumor.

Case series

BENAIM J. [Tumors of the cerebellopontile angle; considerations on 10 cases]. Neurocirugia. 1949-1950;7:105-28. Undetermined Language. PubMed PMID: 14827057. 1)

1) BENAIM J. [Tumors of the cerebellopontile angle; considerations on 10 cases]. Neurocirugia. 1949-1950;7:105-28. Undetermined Language. PubMed PMID: 14827057.

First use of fluorescein sodium guided resection

Fluorescein sodium guided resection

The first use of fluorescence for brain tumour surgery was in 1948 by G.E. Moore 1) using fluorescein sodium, a strongly fluorescing and non-toxic agent.

MOORE GE, PEYTON WT, et al. The clinical use of fluorescein in neurosurgery; the localization of brain tumors. J Neurosurg. 1948 Jul;5(4):392-8. PubMed PMID: 18872412.

First description of Parsonage-Turner Syndrome

The Parsonage Turner syndrome is named after Maurice Parsonage and John Turner and published in the Lancet by Parsonage and Turner .

The condition, subsequently coined Parsonage-Turner Syndrome, had been previously described in the literature as far back as 1897 with many similar clinical presentations of the syndrome reported prior to the extensive study of the syndrome by Parsonage and Turner.

Parsonage Turner syndrome is also known as acute brachial neuropathy and acute brachial radiculitis.

Other names used are Parsonage–Aldren–Turner syndrome, neuralgic amyotrophy, brachial neuritis, brachial plexus neuropathy, or brachial plexitis.


 

PARSONAGE MJ, TURNER JW. Neuralgic amyotrophy; the shoulder-girdle syndrome. Lancet. 1948 Jun 26;1(6513):973-8. PubMed PMID: 18866299.