1/12. Intraoperative mapping of the cortical areas involved in multiplication and subtraction: an electrostimulation study in a patient with a left parietal glioma.OBJECTIVES: Advances in neuroimaging studies have recently improved the understanding of the functional anatomy of the calculation processes, having in particular underlined the central role of the angular gyrus (AG). In this study, the authors applied this knowledge to the surgical resection of a glioma invading the left AG, by localising and sparing the cortical areas involved in two different components of calculation (multiplication and subtraction), using direct electrical stimulations. methods: A calculation mapping was performed in a patient without deficit except a slightly impaired performance for serial arithmetic subtraction, during the resection under local anaesthesia of a left parieto-occipital glioma invading the dominant AG. After somatosensory and language mappings, cortical areas involved in single digit multiplications and subtractions of seven were mapped using the method of electrostimulation, before glioma removal. RESULTS: Distinct sites specifically involved in multiplication or subtraction were detected within the left AG, with a precise spatial distribution and overlapping. All the eloquent (somatosensory, language, and calculation) areas were surgically spared. Postoperatively, the patient had a transient complete deficit for arithmetic subtraction, without either multiplication or language disturbance. The tumour removal was complete. CONCLUSIONS: These findings suggest: firstly, the usefulness of an intraoperative calculation mapping during the removal of a lesion involving the left dominant AG, to avoid permanent postoperative deficit of arithmetic processes while optimising the quality of tumour resection; secondly, the possible existence of a well ordered and dynamic anatomo-functional organisation for different components of calculation within the left AG.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/12. A case of gliosarcoma appearing as ischaemic stroke.OBJECTIVES: Ischaemic stroke attributable to malignant brain tumour is a rarely reported phenomenon and even various imaging techniques including angiography do not necessarily lead to an accurate diagnosis. CASE DESCRIPTION: A 46-year-old, previously healthy man developed apoplectic symptoms with slight right sided hemiparesis and global aphasia. The computed tomography (CT) scan showed lesions of the left temporal lobe and the paraventricular white matter suggestive of left middle cerebral artery (MCA) infarction. Carotid angiography demonstrated compression of the M1 segment of the MCA and occlusion of temporal MCA. The patient initially refused magnetic resonance imaging (MRI) because of claustrophobia. Because of fluctuating symptoms and successive worsening of the condition over weeks an MRI scan was conducted under general anaesthesia. Beneath temporal, opercular, and subcortical infarctions it revealed a left temporal tumour. A tumour biopsy disclosed a gliosarcoma (WHO grade IV). Microscopical examination of the surgical specimen demonstrated invasion of tumour cells into the wall of a greater pre-existing blood vessel. CONCLUSIONS: Malignant brain tumours may cause ischaemic infarction. This is a rare but important differential diagnosis for the origin of strokes. The authors describe the first case with infiltration of intracranial blood vessels by tumour cells of a gliosarcoma.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/12. Cortical mapping and local anaesthetic resection as an aid to surgery of low and intermediate grade gliomas.We report four cases of the use of peroperative cortical mapping during craniotomy under local anaesthesia to define the relationship between the glioma and speech and somatosensory cortex. This enabled a radical subtotal (two cases) or an apparent total (two cases) excision of the tumour close to the somatosensory and speech cortex with no permanent neurological deficit. Use of this technique allows radical excision of intrinsic low and intermediate grade gliomas that would otherwise be considered unexcisable and may lead to an improved survival.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/12. Palliative surgery of acrometastases from lung cancer: a case report.A clinical case of a woman with lung cancer and a very painful bone metastases of the phalangette of the 4th finger of the right hand (acrometastases) is described. Palliative radiation on the 4th finger was not indicated due to almost complete bone destruction. Both patient and daughter refused administration of strong opioids, such as morphine, for pain management, due to fear of addiction and of opioid-related adverse effects. Phalangectomy, with palliative intent, was performed under local anaesthesia, in day surgery, resulting in complete pain relief.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/12. isoflurane in the management of status epilepticus after surgery for lesion around the motor area.When conventional treatment for status epilepticus fails, general anaesthesia is recommended. We present our experience with isoflurane, an inhalational anaesthetic, in the management of four patients with status epilepticus which occurred soon after surgery for motor area lesion. The seizures were controlled with relatively small concentrations of isoflurane. hypotension, the only adverse effect of isoflurane, was managed easily with the use of dopamine in physiological saline. Although status epilepticus occurring soon after surgery is transient, it carries a risk of persistent brain damage if active treatment is not instituted promptly. isoflurane general anaesthesia may be recommended to control it in the intensive neurosurgical care.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/12. anaphylaxis to cisatracurium following negative skin testing.General anaesthesia for the patient with a history of anaesthesia-related anaphylaxis is challenging. Precautions against anaphylaxis and the use of skin test negative drugs can reduce but not eliminate the risk. In the majority of such cases, subsequent anaesthesia is uneventful. However, the absence of a clearly identified triggering agent increases the difficulties facing the anaesthetist. We present a case of anaphylaxis to cisatracurium following a negative skin test.- - - - - - - - - - ranking = 3keywords = anaesthesia (Clic here for more details about this article) |
7/12. Management of labour and delivery in patients with intracranial neoplasms.The presence of an intracranial neoplasm (ICN) during pregnancy has serious implications for the anaesthetic management of labour and delivery. The physiological changes of pregnancy and labour are potentially hazardous to women with ICN, but the provision of adequate pain relief during labour reduces the risk to the mother. Extradural anaesthesia is the only technique that provides pain-free labour reliably, but it carries added risks. Three patients are reported who were managed with extradural anaesthesia: two delivered per vaginam and one by Caesarean section. None suffered any complication related to the anaesthetic technique. At present, there are no published data on the influence of anaesthetic management on outcome of labour and delivery in patients with ICN. Anaesthetists should report such cases so that the relative risks of different management strategies may be assessed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
8/12. Cortical mapping and resection under local anaesthetic as an aid to surgery of low and intermediate grade gliomas.We report four cases of the use of per-operative cortical mapping during craniotomy under local anaesthesia to define the relationship between the glioma and speech and somatosensory cortex. This enabled a radical subtotal (two cases) or an apparent total (two cases) excision of the tumour close to somatosensory and speech cortex with no permanent neurological deficit. Use of this technique allows radical excision of intrinsic low and intermediate grade gliomas that would otherwise be considered unexcisable and may lead to an improved survival.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/12. Thalamic glioma. An unusual presentation.Thalamic gliomas, because of their anatomical location, usually present with early and extensive neurologic signs. A case, which at initial presentation had subjective hemianaesthesia, but no objective neurologic deficit, is being reported, to emphasize the importance of proper investigations even in absence of clinical signs.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
10/12. Inverse activity of masticatory muscles with and without trismus: a brainstem syndrome.Clinical and EMG findings in 10 cases of intrinsic brainstem lesions are reported with paradoxical activity of jaw closing muscles during jaw opening, with and without trismus. In five cases with trigeminal anaesthesia, the inverse activity of jaw closers is interpreted as a manifestation of disturbance in the central programming of mastication in the motor trigeminal area of the brainstem. Stretch reflex mechanisms and disinhibition of the trigeminal motor neurones play no part in the origin of inverse activity. The distinct brainstem syndrome can only be detected by EMG and the special clinical features.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
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