DEHs are highly unpredictable and continue to cause diagnostic difficulty. Close observation for signs of clinical deterioration and repeat CT scan are the most important factors for early detection of DEH. Early diagnosis and prompt operation offers excellent results for DEHs.
Inspite the new informations about the physiology and biochemistry of pain, it remains true that pain is only partially understood. Cancer pain is often experienced as several different types of pain, with combined somatic and neuropathic types the most frequently. If the acute cancer pain does not subside with initial therapy, patients experience pain of more constant nature, the characteristics of wich vary with the cause and the involved sites. Chronic pain related to cancer can be considered as tumor-induced pain, chemotherapy-induced pain, and radiation therapy-induced pain. Certain pain mechanisms are present in cancer patients. These include inflammation due to infection, such as local sepsis or the pain of herpes zoster, and pain due to the obstruction or occlusion of a hollow organ, such as that caused by large bowel in cancer of colon. Pain also is commonly due to destruction of tissue, such as is often seen with bony metastases. Bony metastases also produce pain because of periostal irritation, medullary pressure, and fractures. Pain may be produced by the growth of tumor in a closed area richly supplied with pain receptors (nociceptors). Examples are tumors growing within the capsule of an organ such as the pancreas. Chest pain occurring after tumor of the lung or the mediastinum due to invasion of the pleura. Certain tumors produce characteristic types of pain. For example, back pain is seen with multiple myeloma, and severe shoulder pain and arm pain is seen with Pancoast tumors.
Meningiomas, usually histologically benign tumors, are originating from the arachnoidal cap cells normally present intracranially in varying sites. Olfactory groove meningeomas arise from the medline of the anterior fossa between the crista galli and the tuberculum sellae. The most common presenting symptoms are the visual field defects, epilepsy, and psychological change. They are often large before they are detected because of slowly asymptomatic growing in the interhemispheric space of the frontal lobes. This series is consisted of 29 patients suffering from olfactory groove meningiomas treated surgicaly between May 1992 and November 2003. The surgical results and complications are presented and analized, comparing them by the other reported series.
Postherpetic intercostal neuralgia proved to be an incapacitating pain often recalcitrant to therapy. Acute pain that accompanied Herpes zoster usually subsides spontaneously but in 10% of patients the pain persists and intensifies. The incidence of postherpetic neuralgia incrises up to 50% among elder patients. We report the case of the two 42 and 48 yers old male patient who were succesfuly relieved from the chronic postherpetic intercostal neuralgia employing the DREZ surgery (Dorzal Root Entry Zone lesion). DREZ surgicall treatment of this pain should be considered when medical therapies failed in controling pain. Subjective sensory nature of the pain should play an important role in setting the indication for DREZ surgical treatment. The most favourable pain pattern for DREZ operation is the pain of intermittent rhythm, confined theritory accompanied with the phenomenon of alodinic pain that could be provoked from the pain theritory.
In past, cavernoma was frequently cause of symptomatic epilepsy without pathological supstrat. We present the group of the patient (32) who illness were presented by epilepsy, and who were treated in Institut for Neurosurgery from 1998 to 2003. There is the good correlation between presentation of epilepsy and largness of the cavernoma (Phi 0.683). In 22 patinets the epilepsy was controlated by medicaments, and in other the seayurs were uncontrolled. Cavernoma initially presented with seayures had no inclination for massive intralesional or parenhimal bleeding. After surgical extirpation of leasion, there was good outcome during the following period of 3 years
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