1,720,981 research outputs found
Spontaneous regression of a thoracic calcified disc herniation in a young female: A case report and literature review
No full text[No abstract available
Gliomatosis cerebri treatment in 11 elderly patients
No full textThe Authors report their experience in the treatment of eleven patients over 70 years old (range from 70 to 83, average age 74.8, 7 males and 4 females), with histologically proven diagnosis of glioblastoma multiforme. The GC golden standard treatment is still debated, particularly in elderly patients. All the patients underwent a first line treament with chemotherapy (Temozolomide), followed by Whole Brain Radiotherapy (WBRT) and PCV schedule without Vincristine in case of progression of the disease. The median survival was 16.3 months, ranging from 13 to 22 months. According to our experience, elderly patients should undergo the same treatment of younger patients, provided they are in good health conditions
Benign osteoblastoma of the odontoid process of the axis with secondary aneurysmal bone cyst component: a case report
No full textThe authors report their experience on one
patient with osteoblatoma of the odontoid process of the
axis with secondary aneurysmal bone cyst. According to
their knowledge, this is the first case, reported in the
literature, of this kind of lesion in that particular
anatomical region. Because of the rarity of this lesion, it
was difficult to have a certain preoperative diagnosis.
Therefore, the patient underwent a biopsy via a transoral
route. The biopsy was performed over the noncalcified
component of the lesion. The intraoperative histological
examination showed the benign nature of the lesion.
Thereafter, the lesion was totally removed, succeeding in
preserving the remaining part of the odontoid process and
the anterior arch of C1. In the follow-up, there was no
evidence of cranio-vertebral instability. The histological
examination revealed an osteoblastoma of the odontoid
process of the axis with a secondary aneurysmal bone
cyst. To the best of our knowledge, this is the first case
reported in the literature
Mesenchymal Stem cells (MSCs) in lumbar spine surgery: a single institution experience about red bone marrow and fat tissue derived MSCs. Clinico radiological remarks on a consecutive series of 22 patients.
No full textAIM:
Mesenchymal stem cells (MSCs) are undifferentiated, multipotent cells, which have the ability to self-renew and differentiate into many tissue types. MSCs have shown therapeutic applications in different medical fields and could represent a successful treatment of degenerative disc disease (DDD). Several studies have demonstrated, ex vivo or in animal models, the MSCs efficacy in spine surgery. The authors aim to demonstrate their efficacy in humans.
METHODS:
22 consecutive patients, who suffered of spine DDD, were submitted: in 11 cases the MSCs were harvested from red bone marrow, 11 from fat tissue. The red bone marrow withdrawal was performed from the vertebral bodies; processed by a fully-automated, mobile system. The fat tissue withdrawal was acted from the subcutaneous adipose tissue; processed through a microfluidic fractioning procedure. MSCs were implanted in the central part of the nucleus pulposus of the DDD or added to bone chips to accelerate posterolateral arthrodesis.
RESULTS:
All the 14 posterolateral fusions and MSCs implantations showed at three months a complete bone bridge, stable at follow-up. The one intersomatic implantation gained a complete interbody fusion after 1 month; while 80% black discs treated with MSCs presented a new T2-W hyperintensity at postoperative MRI. The mean VAS pain score improved from 70±20 to 10±5 at 12 months, as the ODI score from 70±5% to 20±10%.
CONCLUSIONS:
There are several questions that need to be answered but MCSs look promising in lumbar spine surgery, both to block the aging of the disc both to accelerate the fusion processes in arthrodesi
Development of a delayed acute epidural hematoma following contralateral epidural hematoma evacuation. case report and review of literature
No full textThe formation of a post-traumatic delayed epidural hematoma (DEDH) is a rare but well-described complication in the literature. It is defined as an extradural bleeding not evident at the first computed tomography (CT) scan performed after trauma, but evidenced by further radiological evaluations. The most supported hypothesis about the mechanism responsible for the formation of a DEDH concerns above all the loss of a tamponade effect given by the reduction of intracranial pressure with medical or surgical treatment. A 30-year-old man was admitted to the emergency department with an epidural hematoma (EDH) associated with a linear calvarial bitemporal coronal fracture. A few hours after the surgical procedure for hematoma evacuation, the patient developed a DEDH contralateral to the site of surgical procedure. The literature review identified other 27 analogue cases. The presence of a calvarial fracture contralateral to the site of a craniotomy and the intraoperative brain swelling during EDH removal are suspicious for the development of DEDH. A CT scan has to be urgently performed in this situation. The timing of postoperative radiological examinations after EDH removal has to consider possible complications and has to be balanced on the basis of patient’s clinical condition and neuroradiological data, such as skull fractures or intraoperative anomalies. The development of a DEDH after the surgical removal of an EDH is a rare event, characterized by a high mortality rate. DEDH develops preferentially on the contralateral side and with a concomitant skull fracture
Extradural hemorrhagic spinal cavernous angioma in a paucisymptomatic child: A rare case with review of the current literature
Full text linkBACKGROUND: Cavernous angiomas, also referred to as cavernous hemangiomas or cavernomas (CMs), are vascular malformative benign neoplasms that may develop in any part of the central nervous system. Spinal CMs are uncommon (overall incidence rate of 0.04–0.05%). Pure epidural CMs account for 1–2% of all spinal CMs and 4% of all spinal epidural tumors. Diagnosis is extremely rare in the pediatric age. To the best of our knowledge, only 10 cases have been described so far. The treatment of choice is microsurgical resection. CASE DESCRIPTION: We describe here the rare case of a cervicothoracic hemorrhagic spinal epidural cavernoma in a paucisymptomatic, 8-year-old female Bangladeshi child. C7–T2 laminectomy with excision of a scarcely defined, capsulated dark red lesion was performed with good recovery. CONCLUSION: Spinal epidural cavernomas are rare. Childhood presentation is even rarer. The reason could be found in a greater “compliance” and to a rarer occurrence of acute bleeding in children, thus resulting in a delayed diagnosis. Surgical excision is the gold standard of treatment
Cervical posttraumatic unilateral locked facets
No full textStudy Design: Radiographic and clinical analysis. Objective: Review author's experience with anterior discectomy, interbody fusion, and anterior cervical plating in 33 patients with posttraumatic unilateral cervical locked facets. Summary of Background Data: Unilateral cervical locked facet syndrome is a relatively uncommon injury that often is misdiagnosed and therefore subject to a dangerous delay in surgery. Management of this trauma is controversial. Materials and Methods: Thirty-three patients with radiologically proven diagnosis of postraumatic unilateral cervical locked facets were treated by skull traction and surgical operation from January 2005 to December 2009. All patients preoperatively were assessed for neurological examination and underwent x-rays, magnetic resonance imaging, and computed tomography evaluation of the cervical spine. Results: The unilateral locked facet level was C4-C5 in 13 patients, C5-C6 in 10, C6-C7 in 8, and C3-C4 in 2 patients. After closed reduction attempt with Crutchfield system, the correct alignment was achieved in 30 patients, who underwent anterior discectomy with cage, interbody fusion, and anterior cervical plating. In 3 patients there was an overdistraction and therefore a closed reduction was not possible, so they were firstly operated by posterior approach with opened reduction of the facets, lateral mass screws, and posterolateral fusion. In 2 of these patients there was an anterior fragment of the disk in the canal, so was also performed an anterior approach with discectomy, cage, and plating. There were no surgery-related complications. Postoperative neurological status was unchanged in the 3 patients with tetraplegia and improved in 8 of the 10 patients with radiculopathy. Fusion was obtained in all patients, as showed in the clinical and radiologic follow-up. Conclusions: The authors conclude that an anterior approach provides a safe and effective alternative for the treatment of patients with posttraumatic unilateral cervical locked facet, when preoperatively the cervical alignment of the dislocation is achieved with a closed reduction
Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report
Full text linkVertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma (SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebral body and venous congestion due to a traumatic injury can provoke SDH. To our best knowledge, only 4 cases of spinal subdural hematoma following a transpedicular vertebroplasty have been previously described in International literature and only one of them occurred two weeks after that surgical procedures. Percutaneous verteboplasty is a well-known treatment of pain oncologic spine disease, used to provide pain relief and improvement of quality life and is considered a simple surgical procedure, involving a low risk of complications, but related to high morbidity, such as SDH. Therefore it has to be performed by experienced and skilled surgeons, that should also recognize possible risk factors, making SDH more risky
The only case of mycotic aneurysm of the PICA: Clinical-radiological remarks and review of literature
No full textAssociation between spontaneous intracranial epidural hematoma and craniofacial infections: a systematic literature review
Full text linkBackground: Spontaneous and nontraumatic epidural hematoma (SEDH) is a rare entity. Etiology is various, including vascular malformations of the dura mater, hemorrhagic tumors, and coagulation defects. The association between SEDH and craniofacial infections is rather unusual. Methods: We performed a systematic review of the available literature using the PubMed, Cochrane Library, and Scopus research databases. Literature research was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We exclusively included studies reporting demographic and clinical data, published until October 31, 2022. We also report one case from our experience. Results: A total of 18 scientific publications, corresponding to 19 patients, met the inclusion criteria for the qualitative and quantitative analysis. Patients were mostly adolescents, with a clear male predominance. SEDHs frequently occurred in the frontal area, usually near the site of the infection. Surgical evacuation was the treatment of choice with good postoperative outcomes. Endoscopy of the involved paranasal sinus should be achieved as soon as possible to remove the cause of the SEDH. Conclusion: SEDH may occur as a rare and life-threatening complication of craniofacial infections; therefore, prompt recognition and treatment are mandatory
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