1,721,020 research outputs found
The C2-tongue connection: anatomically tasteful but often forgotten
No full textStatement We present a case of post-operative numbness of the tongue after surgical resection of an intradural C2 meningioma. This case report is the first to describe an ipsilateral numbness of the tongue after manipulation of the C2 nerve root in spinal meningioma surgery. The underlying explanatory anatomy for the clinical symptoms has previously been described in the neck-tongue syndrome. This anatomical relationship is particularly interesting, but also important for spine surgeons performing complex cervical spine procedures. Clinical description A 50-year-old patient was referred to our neurosurgical department with a cerebellopontine angle meningioma. During the diagnostic work-up, a large right-sided intraspinal extramedullary mass at the second cervical level was identified , causing compression of the spinal cord. MRI imaging showed an intraspinal extramedullary retro-corporal mass at the base of the C2 vertebra compatible with a meningioma (Fig. 1). In consultation with the multidisciplinary surgical team, the spinal meningioma at C2 was treated first. The surgery was performed using intra-operative neuromonitoring using somatosensory evoked potentials (SEPP) and motor evoked potentials (MEP) in collaboration with the neurology department. The intradural mass was visualized after a C2 laminectomy and durotomy. The mass was totally resected (Simpson grade II). The C2 nerve root was not sacrificed, nor the dentate ligament was cut. SEPP and MEP signals remained uninterrupted during the procedure. Post-operatively the patient had post-operative nausea and vomiting (PONV) and complained of right-sided numbness of the tongue, auricular pain and irritation of the skin on and behind the ear. The rest of the clinical examination was completely normal. The patient was able to leave the hospital after 1 week. Histopathological examination confirmed a WHO-grade 1 meningioma. One month after the surgery, the patient was seen at the neurosurgical outpatient clinic. The numbness of the tongue and auricular pain improved significantly. The residual symptoms consisted of some numbness posteriorly to the ear on her head. The patient was informed that further improvement could be expected over time. A post-operative MRI scan was performed to confirm the extent of the resection. This MRI scan showed no residual meningioma (Fig. 1). Discussion and conclusion We hypothesized that the symptoms could be explained by the anatomical relation between the hypoglossal nerve and the cervical nerve roots. This anatomical correlation was initially mentioned in the literature as neck-tongue syndrome. The neck-tongue syndrome is a rare condition characterized by pain in the upper cervical/occipital areas associated with ipsilateral glossal paresthesia, mostly after sudden neck movement [1]. Anatomical studies have illustrated the association between the cervical plexus and the hypoglos-sal nerve. Lance and Anthony were the first to describe the anatomical correlation between the hypoglossal nerve and * Raymaekers Vincen
Recent advances and future directions in spinal cord stimulation for chronic pain: a multidisciplinary perspective
No full textPurpose of reviewThis review aims to provide a comprehensive, multidisciplinary perspective on recent advancements and future directions in spinal cord stimulation (SCS) for chronic pain management. It emphasizes the evolving science of patient selection, technological innovations, cost-effectiveness considerations, and future direction of SCS in pain medicine.Recent findingsSignificant progress has been made in optimizing patient outcomes through refined patient selection, including validated data driven predictive tool which integrated psychological profiling and standard trial stimulation protocol. Technological advancements such as closed-loop stimulation and new waveform have improved efficacy, durability, and patient satisfaction. While SCS is cost-effective in high-income countries, economic evaluations in low- and middle-income settings, such as Thailand, have not yet considered it a cost-effective treatment due to differences in willingness to pay and the cost of conservative treatment. Future direction of SCS may include, restorative SCS for spinal cord injury, new waveforms such as sub-perception stimulation, and multimodal neuromodulation.SummarySCS has undergone many significant transformations in recent years. The integration of clinical, psychosocial and technological knowledge are and will be the key success factors of this transformation. Multidisciplinary collaboration, ongoing research, and the adoption of advanced technologies promise to further personalize and advance therapy
Twiddler's syndrome after dorsal root ganglion stimulation: A case report
No full textDorsal root ganglion stimulation (DRG-S) is a promising therapy for chronic neuropathic pain, but complications of this therapy are poorly understood. Twiddler's syndrome, a rare complication characterized by lead displacement and coiling of wires, has been reported in other neuromodulation devices, but has not been described in the context of DRG-S. Here, we present a first-of-a-kind case report of Twiddler's syndrome occurring after 8 months of DRG-S. This case report highlights the importance of considering Twiddler's syndrome as a potential complication in patients undergoing DRG-S, especially in those with significant weight loss history
An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature
No full textA nontraumatic spontaneous spinal acute subdural hematoma (sSDH) is a rare complication after spinal surgery. Although an sSDH is often associated with anticoagulation therapy, vascular malformations, or lumbar puncture, the pathogenesis of nontraumatic spontaneous sSDH remains unclear. We present the case of an intradural hematoma after an extraforaminal surgery through the Wiltse approach for an extraforaminal disk herniation at L5/S1. This 58-year-old woman experienced hypoesthesia and progressive motor dysfunction in the left leg several hours postoperation. Urgent magnetic resonance imaging revealed an intradural hematoma at the L1/L2 to L2/L3 level in the ventral dural sac proximal to the surgical level. Surgical decompression was performed. There was no evidence of trauma, coagulopathy, or anticoagulation therapy. To our knowledge, this case is the first to report an acute sSDH proximal to the surgery level after an extraforaminal spinal surgery through the Wiltse approach for an extraforaminal disk herniation. It illustrates that attentive postoperative neurologic monitoring, even in the absence of intraoperative irregularities, remains important to diagnose and treat this complication at the early stage.Plazier, M (corresponding author), Jessa Hosp, Dept Neurosurg, Campus Virga Jesse, B-3500 Hasselt, Limburg, Belgium.
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What to know about schwannomatosis: a literature review
No full textBackground Schwannomatosis is a relatively rare disorder and is related to neurofibromatosis type 2. Although there is clinical overlap between schwannomatosis and neurofibromatosis type 2, these diseases have to be regarded as separate entities due to the genetic origin and course of the disease. Methods A comprehensive review of the literature was conducted for relevant studies using Pubmed and Cochrane databases to discuss the epidemiology, clinical presentation, diagnostic criteria, pathological and imaging features, treatment and genetics of schwannomatosis. Results Germline mutations SMARCB1 and LZTRI together with the NF2 gene play a role in the pathophysiology of schwannomatosis. The most common symptom is pain with affection of the spine and peripheral nerves in the majority of patients. High quality contrast enhanced MRI scan is the imaging modality of choice. Treatment is conservative if asymptomatic and surgical if symptomatic. The goal is symptom control with preservation of neurological function. Conclusion Schwannomatosis is a relatively rare disorder in which the main goal is to preserve neurological function.Schraepen, C (corresponding author), Katholieke Univ Leuven, Fac Med & Life Sci, Leuven, Belgium.
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Cerebral dural arteriovenous fistulae presenting with acute hemorrhage: A systematic review
No full textBackground: Cerebral dural arteriovenous fistulae (dAVFs) are rare connections between arteries and veins or sinuses in the brain. dAVFs have a higher risk of intracranial hemorrhages due to increased venous pressure. Endovascular treatment is considered the first line treatment. However, it is unknown if surgery improves outcomes for patients presenting with an acute hemorrhage. Therefore, this systematic review assesses complete obliterations and recurrences of surgery and endovascular treatment in hemorrhagic dAVFs patients.Methods: A literature search in the PubMed and Web of Sciences database was conducted up till October 2021. Studies of surgical and endovascular treatments with hemorrhagic dAVFs were included. The Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group and the JBI critical appraisal checklist for case reports were used for risk of bias assessment.Results: Eleven articles were included. 681 dAVFs patients with 686 fistulae were reported. 245 (36 %) patients presented with an intracranial hemorrhage. Most fistulae were found in the transverse or sigmoid sinuses (n = 220; 32.1 %) and the majority were classified as Borden III. 571 endovascular treatments resulted in 390 (68.3 %) complete dAVF obliterations and there was a recurrence of 66 dAVFs (16.9 %). 183 surgeries resulted in the complete obliteration of 166 fistulae (91.8 %) with a recurrence of 2 dAVFs (1.2 %).Conclusions: Due to the lack of literature on hemorrhagic dAVFs exclusively, we cannot make a statement on the effectiveness of surgical interventions compared to endovascular treatments. Future studies should report out-comes based on location, previous treatments, and patient presentation
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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