15 research outputs found
Quality of Life After Craniovertebral Junction Meningioma Resection: Shaping the Real Neurologic and Functional Expectancies About These Surgeries in a Contemporary Large Multicenter Experience
No full textObjective: Craniovertebral junction (CVJ) meningiomas are one of the most surgically complex conditions in neuro-oncologic surgery. The aim of this work is to correlate our data with clinical outcome to outline factors leading to a worse functional prognosis. Methods: We analyzed sex, age, clinical presentation, topography, surgical approach, Simpson grade resection, postoperative lower cranial nerve deficits, consistency, histology, site of origin, presence of a capsule, and radiologic and clinical follow-up at 1, 6, and 12 months of 61 patients affected by CVJ meningiomas, operated on in our institution from 1992 to 2014. Results: 78.7% of patients were women (mean age, 52.85 years); the onset symptom was pain in 65.5% of cases. The mean preoperative Nurick grade of the sample was 3.78; the most frequent histologic type was endotheliomatous (42.8%). We treated 22 patients with a posterior median approach (5 with lateral and 17 with posterolateral axial topography); in 39 cases (30 anterolateral and 9 anterior) we performed a posterolateral approach. Gross total removal was achieved in 85.2% of cases. We recorded a final follow-up step overall neurologic improvement in the cohort (average preoperative Nurick grade, 3.81, and at 12 months, 2.13). Twenty-nine patients presented with lower cranial nerve deficit (permanent or transient) and no statistically significant association was found between surgical approach and temporary or permanent postoperative complications. Conclusions: We selected, in our experience, some predictors of worse outcome: preoperative sphincter impairment, absence of a capsule, cranial site of origin, a poor preoperative functional status, and firm consistency of the tumor
Management of calcified thoracic disc herniation using ultrasonic bone curette SONO-PET®: technical description.
No full textThis paper describes the surgical management of a post-traumatic calcified thoracic disc herniation treated using ultrasonic bone curette SONO-PET®. The case described concerns a young man with a symptomatic calcified thoracic disc herniation, who underwent posterolateral approach and transversoarthropediculectomy. Patient underwent posterolateral approach with excellent postoperative results. Neurophysiological monitoring somato-sensory evoked potential (SSEP) and muscle motor evoked potentials (MMEP), inclination of 30° toward the unaffected side of the operating table, the use of Ultrasonic Bone-Curette SONO-PET® and proper reconstruction of the three floors of the back muscles allows the removal of the disc herniation safer and risk's free, and less invasive for the patient
Post-traumatic Collet-Sicard syndrome: personal observation and review of the pertinent literature with clinical, radiologic and anatomic considerations
No full textStudy design The lesion of the lower four cranial nerves,
commonly called Collet–Sicard syndrome, can be caused
by a blunt head and neck trauma. It may be associated to an
isolated fracture of the occipital condyle or of the atlas.
Objective The aim of this report is to assess the modality
of the trauma, the type of fracture, the anatomic characteristics,
the treatment and clinical results of this syndrome.
Summary of background data We discuss 14 cases of
fracture of occipital condyle and of atlas and 1 personal
case.
Methods We analyzed 14 cases collected from the literature
between 1925 and 2013, reported a further personal
case and performed an anatomical study of the paracondylar,
atlas and styloid process region. The anatomical
dissection was performed to assess the anatomic relationships
in the site of transit in which the nerves IX, X, XI and
XII are injured.
Results A total of 14 cases of p-CSS were collected: 9
caused by a condyle fracture and 5 by an atlas fracture. The
patients were 13 males and only 1 female, 10 of them had a
blunt trauma due to the result of axial loading (force directed
through the top of the head and through the spine) falling on
the head. The nine cases with a condyle fracture were
associated to the dislocation of part of it, while those with
atlas fractures showed the fracture and/or disjunction of the articular mass. The anatomical evaluations reveal that the
lower four cranial nerves, at their emergency, pass through a
close osteo-ligamentous space in relationship to the condyle.
Below they run through a little wider channel between the
articular mass of C1 and the styloid process. Two cases
underwent surgical procedure. All the other cases were
treated conservatively with immobilization of the cervical
spine. During follow-up three cases with condylar fractures
were found to be clinically unchanged and six showed
modest improvements while one case with atlas fracture had
a complete recovery and four improved significantly.
Conclusions The p-CSS is caused by force directed through
the top of the head.Wesuppose that the nerve injuries are due
to their laceration caused by a displacement of a condyle
fragment or to their compression and stretching when they
pass between the lateral mass of the atlas and the styloid
process. Thesemodalities of traumaexplain the better clinical
results in patients affected by C1 fractures. Conservative
treatment is the option of choice. Surgical option, when
choosed, is not considered to fix nerve damages
First description of cervical intradural thymoma metastasis
No full textThymoma and thymic carcinoma are rare epithelial tumors, which originate from the thymus gland. According to the World Health Organization there are "organotypic" (types A, AB, B1, B2, and B3) and "non-organotypic" (thymic carcinomas) thymomas. Type B3 thymomas are aggressive tumors, which can metastasize. Due to the rarity of these lesions, only 7 cases of extradural metastasis are described in the literature. We report the first and unique case of a man with cervical intradural B3 thymoma metastasis. A 46-year-old man underwent thymoma surgical removal. The year after the procedure he was treated for a parietal pleura metastasis. In 2006 he underwent cervical-dorsal extradural metastasis removal and C5-Th1 stabilization. Seven years after he came to our observation complaining left cervicobrachialgia and a reduction of strength of the left arm. He underwent a cervical spine magnetic resonance imaging, which showed a new lesion at the C5-C7 level. The patient underwent a surgery for the intradural B3 thymoma metastasis. Neurological symptoms improved although the removal was subtotal. He went through postoperative radiation therapy with further mass reduction. Spinal metastases are extremely rare. To date, only 7 cases of spinal extradural metastasis have been described in the literature. This is the first case of spinal intradural metastasis. Early individuation of these tumors and surgical treatment improve neurological outcome in patients with spinal cord compression. A multimodal treatment including neoadjuvant chemotherapy, surgery and postoperative radiation therapy seems to improve survival in patients with metastatic thymoma
Intramedullary non-specific inflammatory lesion of thoracic spine: A case report
No full textAbstract Background There are several non-neoplastic lesions which mimick intramedullary spinal cord neoplasm in their radiographic and clinical presentation. These can be classified as either infectious (TB, fungal, bacterial, parasytic, syphilis, CMV, HSV) and non-infectious (sarcoid, MS, myelitis, ADEM, SLE) inflammatory lesions, idiopathic necrotizing myelopathy, unusual vascular lesions and radiation myelopathy. Although biopsy may be indicated in many cases, an erroneous diagnosis of intramedullary neoplasm can often be eliminated pre-operatively. Case description the authors report a very rare case of intramedullary non-specific inflammatory lesion of unknown origin, without signs of infection or demyelinization, in a woman who showed no other evidence of systemic disease. Conclusions Intramedullary lesions that mimick a tumor can be various and difficult to interpret. Preoperative MRI does not allow a certain diagnosis because these lesions have a very similar signal intensity pattern. Specific tests for infective pathologies are useful for diagnosis, but histological examination is essential for establishing a certain diagnosis. In our case the final histological examination and the specific tests that we performed have not cleared our doubts regarding the nature of the lesion that remains controversial.</p
The trapped girl
No full textIn this #1 Wall Street Journal bestseller, Tracy Crosswhite must first identify the victim to catch the killer. When a woman\u27s body is discovered submerged in a crab pot in the chilly waters of Puget Sound, Detective Tracy Crosswhite finds herself with a tough case to untangle. Before they can identify the killer, Tracy and her colleagues on the Seattle PD\u27s Violent Crimes Section must figure out who the victim is. Her autopsy, however, reveals she may have gone to great lengths to conceal her identity. So who was she running from? After evidence surfaces that their Jane Doe may be a woman who suspiciously disappeared months earlier, Tracy is once again haunted by the memory of her sister\u27s unsolved murder. Dredging up details from the woman\u27s past leads to conflicting clues that only seem to muddy the investigation. As Tracy begins to uncover a twisted tale of brutal betrayal and desperate greed, she\u27ll find herself risking everything to confront a killer who won\u27t go down without a deadly fight. Once again, New York Times bestselling author Robert Dugoni delivers a taut, riveting thriller in the fourth installment of his acclaimed Tracy Crosswhite series.https://scholarship.law.ua.edu/harper_lee_prize_books_2018/1007/thumbnail.jp
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The trapped girl
No full textIn this #1 Wall Street Journal bestseller, Tracy Crosswhite must first identify the victim to catch the killer. When a woman\u27s body is discovered submerged in a crab pot in the chilly waters of Puget Sound, Detective Tracy Crosswhite finds herself with a tough case to untangle. Before they can identify the killer, Tracy and her colleagues on the Seattle PD\u27s Violent Crimes Section must figure out who the victim is. Her autopsy, however, reveals she may have gone to great lengths to conceal her identity. So who was she running from? After evidence surfaces that their Jane Doe may be a woman who suspiciously disappeared months earlier, Tracy is once again haunted by the memory of her sister\u27s unsolved murder. Dredging up details from the woman\u27s past leads to conflicting clues that only seem to muddy the investigation. As Tracy begins to uncover a twisted tale of brutal betrayal and desperate greed, she\u27ll find herself risking everything to confront a killer who won\u27t go down without a deadly fight. Once again, New York Times bestselling author Robert Dugoni delivers a taut, riveting thriller in the fourth installment of his acclaimed Tracy Crosswhite series.https://scholarship.law.ua.edu/harper_lee_prize_books_2018/1007/thumbnail.jp
Combination of pharmacotherapy and lidocaine analgesic block of the peripheral trigeminal branches for trigeminal neuralgia: a pilot study
No full textClassical trigeminal neuralgia (CTN) is treated predominantly by pharmacotherapy but side effects and unsuccessful occurs. The current study was carried out to evaluate the therapeutic effect of combination of pharmacotherapy and lidocaine block. Thirteen patients with CTN managed with pharmacotherapy were recruited and assigned either to no additional treatment (Group I) or to additional analgesic block (Group II). The primary endpoint was the reduction in the frequency of pain episodes in a month assessed at 30 and 90 days. Comparisons of measurements of pain, general health and depression scales were secondary endpoints. The results from the follow-up visits at 30 and 90 days showed the Group II to have larger reduction in the frequency of pain and exhibited a bigger improvement in the scores of the pain, general health and depression scales. The results from this preliminary study suggest a clinical benefit of the combination of pharmacotherapy and lidocaine block
Functional Outcome after odontoid fractures in the elderly
No full textWhile several papers on mortality and the fusion rate in elderly patients treated surgically or non-surgically for odontoid fractures exist, little information is available on quality of life after treatment. The aim of treatment in these patients should not be fracture healing alone but also quality of life improvement. A literature search using PubMed identified seven papers including information on functional evaluation of 402 patients. Patients treated with anterior screw fixation had a good functional outcome in 92.6% of cases. This percentage seemed to decrease in octogenarians. Less information was available for patients treated with posterior approaches; it would seem that up to a half of such patients experienced pain and limitations in activities of daily living after surgery. Patients treated with a halo device had a functional outcome that was worse (or at least no better) than that of patients treated with surgery, with absence of limitations in activities of daily living in 77.3% of patients. Patients treated with a collar had a good functional outcome in the majority of cases, with absence of limitations in activities of daily living in 89% of patients. More studies are needed for evaluation of functional outcome, especially in patients treated with a collar, a halo device or a posterior approach
Evaluation of posttreatment stability after orthodontic treatment in the mixed and permanent dentitions
No full textObjective: To investigate posttreatment changes in the maxillary and mandibular arches in patients who underwent orthodontic treatment during the mixed and permanent dentitions. Materials and Methods: The sample was collected retrospectively from three private practices and consisted of 42 patients who were at least 10 years out of orthodontic treatment. The longitudinal records of study casts and cephalometric radiographs were analyzed to quantify posttreatment changes. Results: Minimal changes in maxillary and mandibular irregularity occurred after an average of 16.98 years from completion of treatment. More than 10 years posttreatment, approximately 81% of the maxillary anterior teeth and 88% of the mandibular anterior teeth showed clinically acceptable incisor alignment (<3.5 mm). Mandibular fixed retainers greatly aided in maintaining the stability of the mandibular incisor alignment. However, posttreatment changes in maxillary incisor irregularity did not appear to be influenced by the presence of a mandibular fixed retainer. When compared with longitudinal changes observed in untreated subjects, the increase in incisor irregularity resembled a pattern similar to the regression line of untreated subjects and seems to be entirely age related. Arch width and arch depth was consistently decreased after treatment, but the magnitude of change was minimal at about 1 mm. No associations were found between any of the cephalometric measurements and changes in incisor irregularities. Conclusions: Orthodontic treatment stability can be achieved and mandibular fixed retention appears to be a valuable contributor, especially in patients with further growth expected.American Association of Orthodontists FoundationSCI(E)[email protected]
