305 research outputs found
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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Rapid ventricular pacing in neurovascular surgery : effectiveness and safety
No full textAbstract: The prevalence in the adult population of unruptured aneurysms varies between 3% and 5%. The most feared complication of a cerebral aneurysm is rupture, leading to a subarachnoid hemorrhage (SAH). The incidence of a SAH, caused by the rupture of an aneurysm is less than 0,02 % a year. The therapy of a cerebral aneurysm is performed on a selective, case-by-case basis. The three main options are observation, endovascular coiling and microsurgical clipping. Several techniques have been proposed to decrease the intra-aneurysmal pressure, to prevent its premature rupture or to reduce the intraoperative bleeding in case of a rupture during clipping. The most widely used technique for facilitation of the dissection and a better visualisation of the aneurysm, branches and perforators is the temporary clipping of the feeding arteries. Our research project indicates that RVP is a technique well suited in those circumstances where short, repetitive flow arrests are adequate to allow the neurosurgeon to manipulate the aneurysm. Rapid ventricular pacing (RVP) enforces ventricular tachycardia, ventricular filling is compromised because of the high rate and the absence of atrioventricular synchrony, leading to decreased blood pressure without causing cardiac arrest and vasodilatation. We demonstrated that RVP is an effective blood pressure lowering technique operating as an on-off mechanism. Blood pressure and CBF dropped with 50% after RVP initiation, remained at that level during the pacing and rebounded to pre-pacing values immediately after RVP cessation. We analysed the effect of RVP on the heart. Our study results indicated that troponin levels increased slightly following RVP and normalised to pre-operative levels 24h after surgery. The intra- and post operatively impact of RVP on the brain was evaluated. We used PbtO2 and rScO2 intra-operatively as measures of cerebral oxygenation. Whereas blood pressure reacts in an on-off mode to RVP, the impact on cerebral oxygenation is delayed and extends beyond the pacing period. Postoperatively, we compared pre- and postoperative MRI to assess the impact of RVP on the brain. No new areas of restricted diffusion were observed in the contralateral hemisphere or posterior fossa. The safe application of RVP requires a concerted effort of the neuro- surgeon and anesthesiologist. Following the conclusion of this research project, the use of RVP in neurosurgical surgery has been reinstated and has been included in the standard intra- operative management of neurovascular clipping in our centre
Thoracic disc herniations : an underestimated disease in search for a surgical cure
No full textAbstract: Although still not widely acknowledged, thoracic disc herniations (TDHs) are not rare lesions that may be observed on MRI scans of asymptomatic individuals (37%; Wood, 1995). Even to date, symptomatic TDHs are underdiagnosed. Their pathogenesis and pathophysiology seems to be different from their cervical and lumbar counterparts, largely involving spinal cord rather than radicular compression. Patients may be incapacitated by myelopathy and/or crippling pain resisting medication, physiotherapy, even invasive pain therapy. Physicians including general practitioners, neurologists, neurosurgeons are insufficiently familiar with their diverse clinical presentation. I started this PhD work to make sure these patients receive the best possible care, regardless whether they are suffering myelopathy or merely pain. I set out to study their very diverse clinical presentation, defining different subgroups encountered in my growing practice, as well as their unique imaging characteristics. Also, after implementation of the thoracoscopic microdiscectomy (TMD) technique (Rosenthal, 1994), I set out to make this technique less invasive, safer, and more efficient. This thesis bundles several papers with regard to these intriguing lesions. First, TDH related acute myelopathy, usually caused by a large preexistent TDH causing important cord compression at the lower end of the thoracic spine, frequently preceeded by dorsalgia. Prognosis tends to be favorable when managed correctly. Second, persisting crippling upper back pain after whiplash and other motor vehicle collisions, caused by a preexistent asymptomatic TDH. Prognosis tends to be favorable when managed correctly. Third, T3-T4 DHs as a unique entity causing severe symptoms despite their usually small dimensions. They can be safely resected using a transaxillary approach. Fourth, a sutureless multi-layer technique to reconstruct the dura during TMD has a 97% success rate in preventing a possibly life-threatening subarachnoid-pleural fistula without converting to open surgery. Fifth, high-risk TDHs which are often giant or massive, calcified, close to the apex of (an accentuated) kyphosis, causing significant spinal canal occupation and spinal cord compression, often accompanied by intramedullary signal changes (myelomalacia). We demonstrate that in experienced hands they can be safely dealt with using TMD with motor evoked potential monitoring support. Finally, TMD-R (\u201cR\u201d meaning rib-preserving) as a safe and effective technique even for the most challenging TDHs, while preserving stability and minimizing acute and chronic postoperative pain, thus opening the door to a more widespread use including patients presenting with merely pain. At the end, some suggestions for future research covering clinical, radiologic, surgical and pathophysiological aspects are discussed
Optimizing use of the Glasgow Coma Scale : review of clinical application and clinimetric characteristics
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Prolonged opioid use after single-level lumbar spinal fusion surgery in a Belgian population: a multicentric observational study
No full textPurpose Lumbar spinal fusion surgeries are increasingly being performed in spinal degenerative disease, often accompanied by perioperative opioid prescriptions. The aim of this study is to analyze prolonged postoperative opioid use following a standardized opioid prescription after single-level lumbar spinal fusion surgery in a Belgian population. Methods This prospective, multicentric observational study included patients undergoing single-level lumbar fusion surgery for degenerative disease. A standardized postoperative opioid protocol (Targinact 2 x 10 mg/5 mg, Paracetamol 4 x 1 g and Ibuprofen 3 x 600 mg) was applied uniformly. Prolonged opioid use was defined as continued opioid use six months after surgery. Patient data were collected using the Back-App (R). Results Among 198 participants, 32.8% continued opioid use six months post-surgery, with 8% utilizing strong opioids. Prolonged opioid use correlated with lower pre-operative back pain. Patients with prolonged opioid use and strong opioid use at six months show less improvement in disability compared to patients without prolonged opioid use. Moreover, patients with prolonged strong opioid use tend to have lesser improvement of the low back pain. The odds for prolonged opioid use decrease with the increase of the improvement in ODI. Conclusion 1 in 3 patients undergoing single-level lumbar spinal fusion surgery is at risk for prolonged opioid use. The study underscores the importance of tailored pain management strategies, particularly given the rising prevalence of spinal fusion surgeries. The association between pre-operative low back pain, post-operative improvement in functionality (ODI), and prolonged opioid use emphasizes the need for judicious opioid prescribing practices and highlights the role of functional outcomes in treatment goals.This investigator-initiated study is part of a prospective big data collection in spinal pathology, supported by Medtronic Inc (grant number: NM-3422). Europe. Medtronic was not involved in the collection and analysis of the data, nor in writing the article
Ultrasound Guidance and Monitoring During Burr Hole Intracranial Biopsies: A Perspective from Neurosurgical Hemostasis
No full textCorrection: Prolonged opioid use after single-level lumbar spinal fusion surgery in a Belgian population: a multicentric observational study
No full textThe original article has been corrected. Publisher's note Springer Nature remains neutral with regard to juris-dictional claims in published maps and institutional affiliations. Correction: European Spine Journal h t t p s : / / d o i. o r g / 1 0. 1 0 0 7 / s 0 0 5 8 6-0 2 4-0 8 4 4 8-7 In the original version of this article, the given and family names of all authors were incorrectly structured. The complete correct name should read as follows. Vincent Raymaekers, Gert Roosen, Eric Put, Salah-Eddine Achahbar, Sacha Meeuws, Maarten Wissels, The original article can be found online at h t t p s : / / d o i. o r g / 1 0. 1 0 0 7 / s 0 0 5 8 6-0 2 4-0 8 4 4 8-7
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