Clinical Neuroscience

[Postoperative cerebroventricular collapsus]

NÉMETH Cs. Márta1, ZOLTÁN László2

DECEMBER 22, 1952

Clinical Neuroscience - 1952;5(04)

[1. Clinically and pathologically verifically, 8 PCCs were detected in 7 infra-, 1 supra-tentorial tumors. 3 exited due to PCC, 1 later due to tumor. 4 of our patients were alive and had recovered relative to the biological value of the tumor. 2. Due to the severe disease of PCC, we recommend preventive ventricular drainage and, if the type of surgery and the biological shape of the tumor allow, accurate suturing, especially in posterior scala surgeries. 3. In the case of postoperative hyperthermia, sensory disorders, convulsions, sudden onset of otherwise unjustified paresis, we have to think about PCC, which can be easily diagnosed and treated with the help of ventricular drainage, resp. 4. Ventricular drainage is generally an excellent and secure tool for postoperative monitoring of intraventricular pressure conditions, especially from a differential diagnostic point of view. 5. In the case of PCC, rapid and lasting results can only be expected from filling the ventricular system, which is recommended to be adjuvanted with parenteral fluid intake, aided by Trendelenburg position.]

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  1. Budapesti Orvostudományegyetem Elme- és Idegklinika Idegsebészeti Intézet
  2. Budapesti Orvostudományegyetem Elme- ls Idegklinika Idegsebészeti Intézet

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Clinical Neuroscience

[An interesting case of schizophrenic neologism]

MÁRIA Béla

[We describe a rare case of schizophrenic neologism, where the patient produces larger units of speech that he or she has formed. The neologism is a degradation phenomenon and its development is reminiscent of, but qualitatively different from, infantile and dreaming language. Neologistically formed language is called artificial language. We can distinguish between "intelligible" and "non-intelligible" artificial language. In some cases described in the literature, the artificial language has developed on the ground of pathological religiosity. We will attempt to give a pathogenetic explanation of the neologisms observed in these cases. A closer examination of the regularity of the Pavlovian second signalling system will also provide answers to the unresolved questions of schizophrenic speech disorders and hence neologisms.]

Clinical Neuroscience

[Infancy meningioma]

GÁTAI György

[An unusually large, clinically asymptomatic suprasellar meningioma in a three-year-old boy. One of the youngest meningiomas reported to date. Case presentation and lessons learned: importance of early radical surgery, increased ventriculography in childhood.]

Clinical Neuroscience

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Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

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Clinical Neuroscience

Risk factors related to intracranial infections after transsphenoidal pituitary adenomectomy under endoscope

XU Yifan, HE Yuxin , XU Wu, LU Tianyu, LIANG Weibang, JIN Wei

Background – Up to now, the risk factors related to intracranial infections after transsphenoidal pituitary adenomectomy remain controversial. Purpose – To analyze the risk factors related to intracranial infections after transsphenoidal pituitary adenomectomy under an endoscope, and to provide evidence for preventing and controlling the occurrence and development of infections. A total of 370 patients receiving endoscopic transsphenoidal pituitary adenomectomy in our hospital from January 2014 to October 2017 were selected. The risk factors related to postoperative intracranial infections were analyzed. The hospitalization lengths and expenditures of patients with and without intracranial infections were compared. Of the 370 patients, 18 underwent postoperative intracranial infections, with the infection rate of 4.86%. Intraoperative blood loss >120 mL, cerebrospinal leakage, diabetes, preoperative use of hormones, macroadenoma as well as surgical time >4 h all significantly increased the infection rate (P<0.05). Preoperative use of antibacterial agents prevented intracranial infection. Compared with patients without intracranial infections, the infected ones had significantly prolonged hospitalization length and increased expenditure (P<0.05). Discussion – It is of great clinical significance to analyze the risk factors related to intracranial infection after endoscopic transsphenoidal pituitary adenomectomy, aiming to prevent and to control the onset and progression of infection. Intracranial infections after endoscopic transsphenoidal pituitary adenomectomy were affected by many risk factors, also influencing the prognosis of patients and the economic burden.

Clinical Neuroscience

Review of electrode placement with the Slim Modiolar Electrode: identification and management

CSANÁDY Miklós, JÓRI József, ROVÓ László, DIMAK Balazs, NAGY Roland, PERENYI Adam, JARABIN Andras Janos, SCHULCZ Rebeka, KISS Geza Jozsef

Background - Several cochlear implant recipients experience functionality loss due to electrode array mal-positioning. The application of delicate perimodiolar electrodes has many electrophysiological advantages, however, these profiles may be more susceptible to tip fold-over. Purpose - The prompt realization of such complication following electrode insertion would be auspicious, thus the electrode could be possibly repositioned during the same surgical procedure. Methods - The authors present three tip fold-over cases, experienced throughout their work with Slim Modiolar Electrode implants. Implantations were performed through the round window approach, by a skilled surgeon. Standard intraoperative measurements (electric integrity, neural response telemetry, and electrical stapedial reflex threshold tests) were successfully completed. The electrode position was controlled by conventional radiography on the first postoperative day. Results - Tip fold-over was not tactilely sensated by the surgeon. Our subjects revealed normal intraoperative telemetry measurements, only the postoperative imaging showed the tip fold-over. Due to the emerging adverse perception of constant beeping noise, the device was replaced by a CI512 implant after 6 months in one case. In the two remaining cases, the electrode array was reloaded into a back-up sheath, and reinserted into the scala tympani successfully through an extended round window approach. Discussion - Future additional studies using the spread of excitation or electric field imaging may improve test reliability. As all of these measurements are still carried out following electrode insertion, real-time identification, unfortunately, remains questionable. Conclusion - Tip fold-over could be reliably identified by conventional X-ray imaging. By contrast, intraoperative electrophysiology was not sufficiently sensitive to reveal it.

Clinical Neuroscience

Secretory meningioma with bone infiltration and orbital spreading

GARZULY Ferenc, KÁLOVITS Ferenc, TOMPA Márton, TAKÁTS Lajos, SOMOGYI Katalin, KÁLMÁN Bernadette

Secretory meningioma is a rare form of meningiomas which differentiates from the meningothelial subtype. It is characterized by significant peritumor edema and distinct immunohistochemical and molecular genetic profiles. We present a middle aged female patient with secretory meningioma infiltrating the orbital bone from the primary cranial base location and causing exophthalmos, features rarely described with this tumor. Surgical resection was challenging because of the associated brain swelling and rich vascularization of the tumor. Imaging and immunohistochemical studies revealed characteristic hallmarks of secretory meningioma. While histologically it was a benign tumor, due to the orbital bone and soft tissue infiltration, postoperative management of neurological sequelae was challenging. This case highlights distinctive clinical, imaging and histological features along with individual characteristics of a rare form of meningiomas.

Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

NAGY Ferenc, JANSZKY József, KOMOLY Sámuel, KOVÁCS Norbert, BALÁS István, ASCHERMANN Zsuzsanna, DÓCZI Tamás, DELI Gabriella, BOSNYÁK Edit

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]