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Lumbar drainage

Ishan Shah, Christopher Wang, Nick Jain, Blake Formanek, Zorica Buser, Jeffrey Wang
BACKGROUND CONTEXT: Previous studies have found an association between mental illness and poor outcomes in spine surgery, but little is known about the effects of depression and/or anxiety on the adult spinal deformity population. In addition, most relevant studies exclusively focused on the lumbar spine and had relatively small patient sizes. PURPOSE: The aim of this study was to investigate whether adult spinal deformity patients with depression and/or anxiety have an increased risk of postoperative complications and reoperation following posterior thoracolumbar spinal surgery...
October 5, 2018: Spine Journal: Official Journal of the North American Spine Society
Tamara A Strohm, Seby John, Muhammad S Hussain
Background: Current management of acute spinal cord infarction (SCI) is limited. Lumbar cerebrospinal fluid drainage (CSFD) with blood pressure augmentation is utilized in the thoracic/thoracoabdominal aortic repair and thoracic endovascular aortic repair (TEVAR) populations to increase spinal perfusion pressure. Case description: We identified 3 patients who sustained acute SCI and underwent CSFD and maintenance of elevated mean arterial pressure (MAP) within 24 hours of injury...
2018: Surgical Neurology International
Salah G Aoun, Babu G Welch, Michaela Cortes, Sonja E Stutzman, Matthew C MacAllister, Tarek Y El Ahmadieh, Mohamed Osman, Stephen A Figueroa, Md Jonathan A White, Hunt H Batjer, Daiwai M Olson
BACKGROUND: The pupillary light reflex examination is an intrinsic part of any good neurological exam. It can be affected by injury to the eye itself, the afferent and efferent pathways, and more importantly the brain due to stroke, traumatic brain injury, or toxicity. There has been consistent evidence that automated pupillometry assessment can provide superior accuracy and interrater correlation compared to bedside eye examination. Pupillary indices such as the Neurological Pupil Index (NPI) may also provide the treatment team with several hours of warning prior to the advent of herniation syndromes, or third nerve palsy...
September 26, 2018: World Neurosurgery
Abhijit Pawar, Chirag Manwani, Raghavendra Thete, Mihir Bapat, Vishal Peshettiwar, Satishchandra Gore
STUDY DESIGN: Retrospective study. PURPOSE: In this study, we describe an endoscopic method of effectively treating tubercular lumbar spondylodiskitis with early onset epidural spinal cord compression in the lumbar spine on magnetic resonance imaging (MRI). OVERVIEW OF LITERATURE: Percutaneous aspiration and biopsy of spondylodiskitis under ultrasonography and computer tomography scan invariably provides an inadequate diagnosis. METHODS: From May 2015 to May 2017, 18 patients presented with intractable back pain and were diagnosed with tubercular spondylodiskitis on MRI; these patients were enrolled in this study...
October 2018: Asian Spine Journal
Michel Abdel Malek, Tessa Smissaert van de Haere, Ruud Loffeld
A 74-year-old man presented to the Emergency Department after a fall from a ladder. Plain radiographic screening of the lumbar spine revealed an unanticipated curvilinear, oval-shaped air configuration in the pelvis. Computed tomography of the lumbar spine showed air within the bladder wall and lumen. Urine cultures were positive for Escherichia coli. The patient was discharged after bladder drainage and empiric antibiotic treatment.
September 3, 2018: Nederlands Tijdschrift Voor Geneeskunde
Oliver Enke, Jasan Dannaway, Matthew Tait, Charles H New
Introduction: Incidental durotomy is a relatively common complication of spine surgery. Prevalence ranges from 3 to 5% in primary and 7 to 17% in revision procedures. Despite this relatively common occurrence the subsequent development of pseudomeningoceles following lumbar spine surgery is reported to be between 0.07 and 2%. Giant pseudomeningoceles (GP) are rare and therefore we report our experience with a case. Case presentation: We report a case of an iatrogenic GP post revision lumbar surgery that extended 19 cm in length...
2018: Spinal Cord Series and Cases
Barak Ringel, Narin N Carmel-Neiderman, Aviyah Peri, Daniel Ben Ner, Ahmad Safadi, Avraham Abergel, Nevo Margalit, Dan M Fliss
OBJECTIVES/HYPOTHESIS: Anterior skull base operations pose the risk for postoperative cerebrospinal fluid (CSF) leak. Routine lumbar continuous drainage catheter (LD) placement is intended to decrease CSF leaks and central nervous system (CNS) complications, but there are no sound evidence-based data on its efficacy. The primary goal of this study was to review CNS complications following anterior open skull base surgery and their association with LD placement. The secondary goal was to define predictors for the development of early CNS complications...
September 8, 2018: Laryngoscope
Philippe Lavigne, Eric W Wang, Juan C Fernandez-Miranda
The optimal treatment for skull base chordomas is gross total resection followed by radiotherapy and not radiation of partially resected tumors. Supratotal resection, defined as removal beyond all involved bone and dura, is ideal but difficult to achieve. In this video, we present the case of a 37-yr-old man with new onset of progressive cranial nerve sixth palsy and a skull base lesion compatible with clival chordoma. He underwent partial surgical resection at an outside institution via transcranial approach, with significant tumor residual at the clivus, dorsum sella, posterior clinoids, and petrous apex, extensive dural invasion, and intradural extension with attachment to the basilar artery and its long perforating branches...
September 4, 2018: Operative Neurosurgery (Hagerstown, Md.)
Jackson M May, Mark R Waddle, Daniel H Miller, William C Stross, Tasneem A Kaleem, Byron C May, Robert C Miller, Liuyan Jiang, Gerald W Strong, Daniel M Trifiletti, Kaisorn L Chaichana, Ronald Reimer, Han W Tun, Jennifer L Peterson
BACKGROUND: Histiocytic sarcoma (HS) is an aggressive malignant neoplasm. HS in the central nervous system is exceptionally rare and associated with a poor prognosis. This report documents a case of primary HS of the central nervous system with treatment including surgery, radiotherapy, and chemotherapy. CASE PRESENTATION: Our patient was a 47 year old female presenting with progressive ataxia, headaches, imbalance, nausea, vomiting, and diplopia. MRI showed a heterogeneously enhancing lesion approximately 2...
September 5, 2018: Radiation Oncology
Vincent Keereman, Elise Platteau, Luc Crevits, Luc Algoed
INTRODUCTION: Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a variant syndrome of internuclear ophthalmoplegia, consisting of primary gaze exotropia, adduction impairment, nystagmus of the abducting eye, and vertical gaze-evoked nystagmus. It seems to be most frequently associated with multiple sclerosis, although other etiologies such as brainstem ischemia or hydrocephalus have also been described. CASE REPORT: We report the case of a 25-year-old woman who presented with subacute progressive oculomotor disturbances, resulting in the development of a WEBINO over a few days...
September 2018: Neurologist
Nancy E Epstein
Background: Prior to spine surgery (SS), we ask whether and when to stop low-dose aspirin (LD-ASA), particularly in patients with significant cardiovascular disease (CAD). Although platelets typically regenerate in 10 days, it can take longer in older patients. Methods: Here we reviewed several studies regarding the perioperative risks/complications [e.g. hemorrhagic complications, estimated blood loss (EBL), continued postoperative drainage] for continuing vs. stopping LD-ASA at various intervals prior to lumbar SS...
2018: Surgical Neurology International
Javier Quillo-Olvera, Kutbuddin Akbary, Guang-Xun Lin, Jin-Sung Kim
BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD) has evolved over the last decades and has become an effective treatment for soft disc herniations. However, while its use increases, newer complications have been discovered. CASE DESCRIPTION: Here, the authors present the unique case of a woman who underwent PELD/foraminotomy to treat right side foraminal disc herniations on L4-L5 and L5-S1 in the same procedure. Ten days after surgery patient developed fever and severe low back pain radiated down her right leg...
August 22, 2018: World Neurosurgery
Jochen A Sembill, Hagen B Huttner, Joji B Kuramatsu
PURPOSE OF REVIEW: The present review will cover most recent and important studies on acute treatment of intracerebral hemorrhage (ICH). RECENT FINDINGS: Overly pessimistic prognostication in ICH may deny meaningful recovery achieved by specialized neurocritical care. Hematoma enlargement represents the most important target of acute ICH care, which is reduced by aggressive blood pressure management (targeting a systolic blood pressure of 140 mmHg) and appropriate hemostatic treatment especially in anticoagulation-associated ICH (INR reversal using prothrombin complex concentrates, eventually idarucizumab, andexanet, or tranexamic acid)...
August 20, 2018: Current Neurology and Neuroscience Reports
Luisa Kramer, Vanessa Geib, John Evison, Ekkehardt Altpeter, Jasmin Basedow, Jan Brügger
BACKGROUND: Tuberculosis is the leading infectious cause of death worldwide. Among native Swiss people, tuberculosis is more common in older people than in younger people. Approximately 25-30% of reported cases of tuberculosis are purely extrapulmonary; skeletal tuberculosis is reported in 3-5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of tuberculous sacroiliitis with secondary psoas abscess, as this clinical picture is very rare. CASE PRESENTATION: A magnetic resonance imaging scan of an 85-year-old (Swiss-German) Caucasian woman with chronic left-sided hip pain and limitation of hip joint movement showed a progressive destruction of her sacroiliac joint and a large collection in her left iliopsoas muscle...
August 18, 2018: Journal of Medical Case Reports
Chen Liang, Ling Yang, Shiwen Guo
The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture (LP) and lumbar cerebrospinal fluid (CSF) drainage (LD) of patients with aneurysmal subarachnoid hemorrhage and provide more evidence to guide clinical management. In this retrospective study, 41 and 39 aneurysmal subarachnoid hemorrhage patients were enrolled in the LP and LD group, respectively. Clinical outcomes, including CSF infection, intracerebral hemorrhage, vasospasm, hydrocephalus, death, length of stay, duration of drainage and the Glasgow Outcome Scale score were compared between the two groups...
July 23, 2018: Journal of Biomedical Research
Yuan Hong, Yuanjian Fang, Qun Wu, Jianmin Zhang, Yongjie Wang
INTRODUCTION: Ganglioglioma is a generally benign tumor, mostly occurring in patients <30 years old. Temporal lobe is most frequently involved. Up to now, only 3 cases were reported of ganglioglioma in the pituitary gland, all being confined to the neurohypophysis. Here, we are the first to report an adenohypophysis ganglioglioma. CASE PRESENTATION: A 43-year-old woman presented with chronic headache was referred to our hospital. Magnetic resonance imaging (MRI) indicated pituitary adenoma...
July 2018: Medicine (Baltimore)
M Hulens, R Rasschaert, W Dankaerts, I Stalmans, G Vansant, F Bruyninckx
Fibromyalgia (FM) exhibits characteristics of a neurological disorder, and similarities have been identified between FM and idiopathic intracranial hypertension (IICH). When intracranial pressure rises, the drainage of excess cerebrospinal fluid (CSF) through the subarachnoid space of the cranial and spinal nerves increases. Higher CSF pressure irritates nerve fibers inside nerve root sheaths and may consequently cause radicular pain, as was reported in patients with IICH. Moreover, the cut-off of 20-25 cm H2 0 used to define IICH may be too high, as has been suggested in patients with chronic fatigue syndrome...
September 2018: Medical Hypotheses
H-J Li, D-W Ge, S Zhang, A-J Aisikeerbayi, H Wang, Y-L He, J Bian, X-J Cao, L Yang, J-W Yan
OBJECTIVE: To compare the clinical effects, operation safety and radiation exposure of mini-open TLIF via Wiltse's approach (MOTLIF) and conventional open TLIF (COTLIF) in the treatment of single-segment lumbar degenerative disease via the prospective control study. PATIENTS AND METHODS: A total of 77 patients were enrolled from November 2012 to July 2014, including 42 patients in the mini-open group (MOTLIF) and 35 patients in the COTLIF group. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores before operation, operation time, intraoperative blood loss, postoperative drainage volume, blood transfusion rates, postoperative bedridden time, postoperative hospital stays, intraoperative fluoroscopic time, levels of serum creatine phosphokinase (CPK) before operation, 3 days and 1 week after operation, VAS scores before operation, 3 days and 1 week after operation, and ODI and VAS scores in the last follow-up between the two groups were compared...
July 2018: European Review for Medical and Pharmacological Sciences
Justin Seltzer, Michelle A Wedemeyer, Phillip A Bonney, John D Carmichael, Martin Weiss, Gabriel Zada
OBJECTIVE Incidental pituitary adenomas (IPAs) are commonly discovered during cranial imaging evaluations obtained for unrelated indications. The optimal management of IPA remains controversial. The authors investigated the outcomes and safety of the surgical treatment of IPAs at their institution. METHODS Clinical outcome data for 1692 patients surgically treated for pituitary adenomas at the Keck Medical Center of USC/USC Pituitary Center over a 17-year period (1999-2016) were reviewed to identify all cases with surgically managed IPAs...
June 1, 2018: Journal of Neurosurgery
Toshihiro Ogiwara, Alhusain Nagm, Takatoshi Hasegawa, Yoshiki Hanaoka, Shunsuke Ichinose, Tetsuya Goto, Kazuhiro Hongo
Various skull base reconstruction techniques have been developed in endoscopic endonasal approach (EEA) for skull base lesions to prevent postoperative cerebrospinal fluid (CSF) leakage. This study was performed to evaluate the efficacy and pitfalls of our method of skull base reconstruction after EEA. A total of 123 patients who underwent EEA (127 surgeries) between October 2014 and May 2017 were reviewed. Our algorithm for skull base reconstruction in EEA was categorized based on intraoperative CSF leakage graded as follows: grade 0 was excluded from this study; grade 1, dural suturing with abdominal fat graft or packing of gelatin sponge into the cavity; grade 2, method for grade 1 with addition of mucosal flap or nasoseptal flap (NSF); and grade 3, duraplasty in fascia patchwork closure with NSF...
July 7, 2018: Neurosurgical Review
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