1,721,075 research outputs found
Protective effect of spinal cord stimulation on experimental early cerebral vasospasm - Conclusive results
No full textIn this study we investigate the effects of cervical spinal cord stimulation (cSCS) on experimental 'early spasm' in rabbits as described in personal previous experience (Acta Neurochir 2001;143:177-185). Twenty-four adult red Burgundy rabbits wearing a cervical epidural electrode underwent cerebral blood flow (CBF) and functional monitoring of early basilar spasm before and during cSCS. CBF changes, as a consequence of cSCS, occurred in 20 control animals. No CBF changes, consistent with no basilar artery vasospasm, occurred after subarachnoid haemorrhage (SAH) up to the end of the experiments in all the stimulated animals. The role of reversible functional sympathectomy in mediating the effect of spinal cord stimulation on early spasm is discussed. cSCS is able to prevent 'early spasm' due to SAH in all the animals studied, independently from the occurrence and the sign of stimulation induced CBF variations. Copyright (C) 2002 S. Karger AG, Basel
Craniocervical junction instability: instrumentation and fusion with titanium rods and sublaminar wires. Effectiveness and failures in personal experience
No full textBackground. The aim of the study was to evaluate the effectiveness, pitfalls and failures of instrumentation and fusion with titanium wires and rods in 12 h patients with cramovertebral junction instability. Methods. Among nine adult patients (mean age 48.11 years) with cramovertebral junction instability, four had basilar impression, three metastatic disease, one rheumatoid arthritis and one Down's syndrome. Three children (mean age 7.33 years) with genetic (Down's syndrome, 2 cases) and metabolic (mucopolisaccarydoses type IV, i.e. Morquio Syndrome, I case) disease were studied as well. Each patient underwent preoperative radiological evaluation by means of X-Ray, CT scan and MRI of the craniocervical region. Occipitocervical instrumentation with a titanium U-shaped wired rod was performed in each patient. Autologous bone fusion was performed in all but the two cancer patients, in whom polymethylmetacrylate was used. Postoperatively, all the patients used an external orthosis for 3-6 months. Post-operative X-Ray, CT and MRI were performed on each patient. The Frankel clinical scale was used to asses the outcome at follow-up which ranged from I to 10 years. At maximum follow up, there was either clinical improvement or stabilization recorded in all but one patient. This patient with basilar impression transiently worsened from grade D to C and a spinal cord lesion was already evident before the operation on MRI examination. Interpretation. The effectiveness of surgical management of cramovertebral junction instability by instrumentation and fusion was demonstratedly in our experience. Nevertheless, the choice of the surgical technique should be made with caution when a spinal cord lesion is revealed by preoperative neuroimaging studies
The Decision-Making Process in Traumatic Lesions of the Craniovertebral Junction: An Evidence-Based Approach? Part II.
No full textThis paper is Part II of a two-part report. Part I of the report covered atlanto-occipital dislocation or dissociation, and isolated condylar fractures. This part of the report covers isolated and combination fractures of the atlas and axis
Subacute clinical onset of postraumatic myelopathy
No full textBackground. Subacute neurological deterioration unrelated to mechanical instability is a rare event. Cases report. The authors describe two patients with subacute neurological deterioration unrelated to mechanical instability, which occurred 24 hours after spinal cord injury. The phenomenon could not be prevented by steroid therapy carried out either before or after the onset of clinical signs. An early surgical decompressive procedure performed in one of the two patients, failed to reverse the clinical symptomatology. Findings. In the first case, temporal evolution of the neurological deterioration suggested a venous thrombosis with secondary congestive ischemia. whereas ischemia involving the anterior spinal artery seems to account for the deterioration observed in the second patient. Interpretation. Spinal cord haemodynamics plays the main role in mediating the onset of descending subacute posttraumatic myelopathy. The cure and the prevention of the secondary vascular injury still remains unknown
Is "mini-invasive" technique for iliac crest harvesting an alternative to cervical cage implant? An overview of a large personal experience
No full textAutograft bone provides an excellent substrate for multilevel arthrodesis after anterior discectomy and is inexpensive. However, the use of tricortical bone could increase the discomfort for the patient
Focus on functional delayed central sleep apnea following cervical laminectomy. An example of respiratory dysfunction in restorative neurosurgical procedures
No full textIn sleep-related breathing disorders, sleep apnea is a clinical symptom that can be categorized as obstructive sleep apnea (OSA) or mixed apnea by analysis using poly-somnography. The occurrence of delayed central sleep apnea (CSA) is an extremely rare complication of cervical laminectomy for spondylotic myelopathy. So far only three studies concerning such an event have been reported in the literature. Naim-ur-Rahman, in 1994, reported a case of postoperative CSA following C3-C6 laminectomy, and Visocchi and colleagues, in 2014, in two studies, stressed the lack of association with any other neurological sign of spinal cord damage. No definitive mechanism has been recognized so far for delayed CSA after cervical laminectomy. A transient dysfunction of the reticulo-spinal fibers directed to the nucleus of the phrenic nerve can be speculated, although neither emidiaphragm paralysis, nor any prominent nocturnal sleep- related disorders are associated with this delayed CSA
Walk the Line. The Surgical Highways to the Craniovertebral Junction in Endoscopic Approaches: A Historical Perspective
No full textBackground: We compiled a comprehensive literature review on the anatomic and clinical results of endoscopic approaches to the craniocervical junction (CVJ) to better contribute to identify the best strategy. Methods: An updated literature review was performed in the PubMed, OVID, and Google Scholar medical databases, using the terms “Craniovertebral junction,” “Transoral approach,” “Transnasal approach,” “Transcervical approach,” “Endoscopic endonasal approach,” “Endoscopic transoral approach,” “Endoscopic transcervical approach.” Clinical series, anatomic studies, and comparative studies were reviewed. Results: Pure endonasal and cervical endoscopic approaches still have some disadvantages, including the learning curve and the deeper surgical field. Endoscopically assisted transoral surgery with 30° endoscopes represents an emerging option to standard microsurgical techniques for transoral approaches to the anterior CVJ. This approach should be considered as complementary rather than an alternative to the traditional microsurgical transoral-transpharyngeal approach. Conclusions: The transoral approach with sparing of the soft palate still remains the gold standard compared with the pure transnasal and transcervical approaches because of the wider working channel provided by the former technique. The transnasal endoscopic approach alone appears to be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus
Basilar Invagination, Bone Regrowth, Chiari malformation, Clivus, Odontoid Process, Transoral Odontoidectomy
No full textPurpose: Transoral odontoidectomy followed by occipito-cervical fixation is a widely
used approach to relieve ventral compressions at the craniovertebral junction (CVJ).
Despite the large amount of literature on this approach and its complications, no
previous reports of odontoid process and clival regeneration following transoral
odontoidectomy are present in the English literature.
Methods: We report the case of odontoid process and clival regeneration following
transoral odontoidectomy.
Results: A 7 year-old boy presented with symptoms of brainstem and upper cervical
spinal cord compression due to a complex malformation at the CVJ including a basilar
invagination with Chiari malformation. A successful transoral microsurgical endoscopicassisted
odontoidectomy extended to the clivus was performed. Clinical and
radiological resolution of the CVJ compression was evident up to two years post-op,
when the child had a relapse of some of the presenting symptoms and the follow-up
CT and MRI scans showed a quite complete regrowth of the odontoid process, clival
partial regeneration and recurrence of preoperative Chiari malformation.
Conclusions: A resection of the odontoid down to the dentocentral syncondrosis and
an accurate lateral removal of the bone surrounding the anterior tubercle of the Clivus
is advised when an anterior CVJ decompression is required in children below 10 years
of age.
Powere
Transient breathing disorders after posterior cervical surgery for degenerative diseases: pathophysiological interpretation
No full textCentral sleep apnea is a breathing disorder that manifests as repetitive cessation of the breath during the sleep. The occurrence of breathing disorders after cervical laminectomy has been exceptionally described as a complication after cervical decompressive laminectomy for cervical stenotic myelopathy. In 1994, Naim-ur-Rahman reported the first case of postoperative central sleep apnea following C3-C6 laminectomy, occurring right after surgery and associated with spyncterial incontinence, that spontaneously recovered three weeks after onset. Recently we described a rare complication of cervical laminectomy for cervical stenotic myelopathy: the onset was delayed from surgery (nearly two weeks later) and cervical stenotic myelopathy was not associated to any other neurological sign of spinal cord damage as demonstrated by the neurophysiological assessment. Possible familiar predisposition can be matter of discussion. No definite interpretation of pathophysiological mechanisms can ultimately explain the occurrence of delayed and isolated central sleep apnea after laminectomy for the treatment of cervical stenotic myelopathy. Such a reversible and benign complication remain unpredictable in the best surgical hands
Synovial sarcoma of the parotid gland: A case report and review of the literature
No full textParotid gland tumours are very heterogeneous, being benign in 80% of cases, and generally arising from epithelial cells. Nevertheless, a small group of non-epithelial tumours representing just 5% of all salivary gland neoplasms has also been reported, the most common of these being haemangioma, especially in children. However, lymphomas, neuromas, neurofibromas, lipomas and sarcomas can also be found. Synovial cell sarcoma is a high grade histological variety of sarcoma and is generally located near large joints and bursae of the lower extremities, such as knee, tendon sheaths and bursal structures. It is rarely found in the head and neck region due to its lack of synovioblastic tissue. Herewith, the case of a young female, affected by a synovial sarcoma of the left parotid gland, is presented and a review is made of the literature on this rare specific localization focusing on management and outcome
- …
