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Assaf Berger, Rotem Tellem, Michal Arad, Uri Hochberg, Tal Gonen, Ido Strauss
Pain is one of the most common symptoms among cancer patients, and particularly in those who suffer from metastatic or terminal disease. There is great importance in delivering good pain management to these patients in order to alleviate their suffering, improve their functional status and their overall quality of life. In most cases, pain management is based on pharmacotherapy with opioids and other medications. However, there are selected patients for whom pharmacotherapy does not achieve acceptable pain relief or is associated with marked side effects...
February 2018: Harefuah
Jian Ren, Chuan He, Tao Hong, Xiaoyu Li, Yongjie Ma, Jiaxing Yu, Feng Ling, Hongqi Zhang
STUDY DESIGN: A retrospective review of prospectively collected data. OBJECTIVE: To confirm the feasibility of using anterior to dorsal root entry zone myelotomy (ADREZotomy), a new surgical approach, for the treatment of ventrolateral deep ISCCMs. SUMMARY OF BACKGROUND DATA: Surgical removal of ventrolateral deep intramedullary spinal cord cavernous malformations (ISCCMs) is highly risky and remains problematic. METHODS: The authors performed a retrospective study exploring the surgical removal of ventrolateral intrinsic ISCCMs using ADREZotomy in 10 patients...
February 16, 2018: Spine
Salah G Aoun, Mary Ashley Liu, Megan Still, Tarek Y El Ahmadieh, Mazin Al Tamimi, Wayne Gluf
BACKGROUND: The management of dermoid cysts can be tedious as they have a tendency to recur, and respond poorly to chemotherapy and radiation. Management is especially difficult for tumors involving highly eloquent areas such as the conus medullaris. OBJECTIVE: We aim to provide a summary of the pathology, clinical presentation, and operative management strategies of dermoid cysts involving the conus medullaris. METHODS: Two clinical cases of dermoid cysts of the conus are presented, as well as a commented surgical video...
February 10, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Toshihiro Takami, Kentaro Naito, Toru Yamagata, Nobuyuki Shimokawa, Kenji Ohata
BACKGROUND: Intraoperative image guidance using near-infrared indocyanine green videoangiography (ICG-VA) has been used to provide real-time angiographic images during vascular or brain tumor surgery, and it is also being used for spine surgery. OBJECTIVE: To further investigate the benefits and limitations of ICG-VA image-guided surgery for spinal intramedullary tumors through retrospective study. METHODS: ICG-VA was used in 48 cases that were treated surgically over the past 5 yr...
December 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
Dorota Tassigny, Edward Fomekong, Guus Koerts, Christian Raftopoulos
In the literature, less than ten cases of holocord intramedullary abscess in children have been described. A 15-month-old girl presented with flaccid paraplegia and dermal sinus in the sacral region. MRI highlighted an infected lumbar dermoid cyst. The child underwent surgery to remove the cyst and purulent collection. Five days after surgery, she developed upper limbs paresis. An MRI showed a holocord abscess. A catheter was inserted through a cervical myelotomy into the abscess for drainage with a good postoperative recovery...
January 2018: Acta Neurochirurgica
Aditya Vedantam, Dhanalakshmi Koyyalagunta, Brian Mendoza Bruel, Patrick M Dougherty, Ashwin Viswanathan
BACKGROUND: Limited midline myelotomy targets the midline nociceptive pathway for intractable visceral pain. Multiple techniques are available for limited midline myelotomy; however, outcome data for each technique are sparse. OBJECTIVE: To review our experience with open and percutaneous approaches for limited midline myelotomy for intractable visceral pain. METHODS: Patients who underwent limited midline myelotomy for intractable visceral pain were reviewed...
November 18, 2017: Neurosurgery
Adewale A Bakare, Jonathan Weyhenmeyer, Albert Lee
BACKGROUND AND IMPORTANCE: Perhaps the most disabling condition seen in patients with spinal cord injury is spasticity. Spasticity is characterized as hyperreflexia and hypertonicity as a result of damage to the supraspinal tracts in the aftermath of SCI. Intrathecal baclofen (ITB) is the mainstay therapy for spasticity unresponsive to oral baclofen. One of the problems associated with post-SCI spasticity unresponsive to ITB is development of scar tissue that prevents the diffusion of baclofen in the desired spinal cord area...
October 31, 2017: World Neurosurgery
Vania Pirillo, Andrea Prontera, Paolo Rizzo, Paolo Cipriano Cecchi, Martin Maffei, Andreas Schwarz
Solitary juvenile xanthogranuloma (SJX) of the spine is an extremely rare proliferative histiocytic disorder with only few cases reported in literature. We present the first case of intramedullary spinal SJX. A 22-year-old male presented with a nine-month history of progressively worsening sphincteric disturbances and saddle hypoesthesia. Magnetic resonance imaging showed an intra-axial lesion located in the conus medullaris; T1 hypointense, T2 iso-hyperintense and uniformly enhancing after contrast administration...
September 2017: Journal of Spine Surgery (Hong Kong)
Masahiro Sawada, Toshihiro Munemitsu, Masato Hojo
BACKGROUND AND IMPORTANCE: During intramedullary lesion surgery, the lesion site and the posterior median sulcus (PMS) should be accurately identified prior to myelotomy to avoid severe injury of the posterior funiculus. However, intramedullary lesions are fundamentally invisible until the myelotomy is performed. Furthermore, the PMS location is frequently unclear due to lesion-induced swelling or distortion of the spinal cord. Intraoperative indocyanine green videoangiography (ICG-VA) followed by FLOW 800 analysis, which shows vascularization of the spinal parenchyma, may provide a solution for these problems in specific cases...
October 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
Richard T Layer, Thomas R Ulich, Domagoj Coric, Paul M Arnold, James D Guest, Robert H Heary, Patrick C Hsieh, Arthur L Jenkins, Kee D Kim, K Stuart Lee, Lorianne K Masuoka, Kristin M Neff, Wilson Z Ray, Nicholas Theodore, Michael G Fehlings
No abstract text is available yet for this article.
September 1, 2017: Neurosurgery
Toshihiro Takami, Kentaro Naito, Toru Yamagata, Shinichi Kawahara, Kenji Ohata
BACKGROUND: Selection of the access myelotomy is a key issue in surgery for spinal intramedullary tumors. This study focused on surgical outcomes with the posterolateral sulcus (PLS) approach, equivalent to dorsal root entry zone myelotomy. METHODS: This retrospective study of the 10-year period from 2007 to 2016 included 90 cases of spinal intramedullary lesions (99 operations). A PLS approach was indicated for intramedullary lesions situated laterally in the spinal cord showing no contact with the spinal cord surface...
December 2017: World Neurosurgery
Masoud Zeinali, Hosein Safari, Saleh Rasras, Reza Bahrami, Mahdi Arjipour, Nima Ostadrahimi
The ventriculus terminalis (VT) is a small ependyma-lined cavity within the conus medullaris that is in direct continuity with the central canal of the spinal cord. Cystic dilatation of the ventriculus terminalis on its own is an extremely rare pathological event in adults whose pathogenesis is uncertain. VT has been described in children as a normal developmental phenomenon. These lesions are often diagnosed incidentally during imaging and are in most cases asymptomatic, especially in children. Symptomatic dilatation of VT in adults is a rare condition with 61cases being reported to date...
June 15, 2017: British Journal of Neurosurgery
Bunpot Sitthinamsuwan, Pornchai Khumsawat, Luckchai Phonwijit, Sarun Nunta-Aree, Akkapong Nitising, Sirilak Suksompong
STUDY DESIGN: This research is a retrospective study. OBJECTIVE: To study the therapeutic effects of operative procedures, including dorsal longitudinal myelotomy (DLM) and dorsal root entry zone lesion (DREZL) on spasticity and associated aspects. SETTING: Tertiary university hospital in Bangkok, Thailand. METHODS: Eighteen patients with refractory spasticity of spinal origin who underwent the operations were recruited...
2017: Spinal Cord Series and Cases
Jun Seok Lee, Geun Sung Song, Dong Wuk Son
Syringomyelia associated with tuberculous meningitis is an extremely rare condition. Only a few studies have reported clinical experience with syringomyelia as a late complication of tuberculous meningitis. Twenty-six years after a tuberculous meningitis episode, a 44-year-old man presented with progressively worsening spastic paresis of the lower limbs and impaired urinary function for 2 years. Radiological examination revealed syringomyelia extending from the level of C2 to T9 and arachnoiditis with atrophy of the spinal cord between C2 and T3...
April 2017: Korean Journal of Neurotrauma
Liang Zhang, Zhifeng Zhang, Wuyang Yang, Wenqing Jia, Yulun Xu, Jun Yang
BACKGROUND: Cystic dilation of the ventriculus terminalis (CDVT) is a rare anatomic variation that and may become symptomatic. Literature regarding CDVT is limited, and thus the clinical characteristics and management strategy of CDVT are unclear. Here we report 6 cases of CDVT seen in our institution, and provide a review of the current literature. METHODS: The study cohort comprised 6 patients with CDVT seen at Beijing Tiantan Hospital between September 2010 and June 2015...
August 2017: World Neurosurgery
Gabriel Guizar-Sahagun, Angelina Martinez-Cruz, Rebecca E Franco-Bourland, Eduardo Cruz-García, Alvaro Corona-Juarez, Araceli Diaz-Ruiz, Israel Grijalva, Horacio J Reyes-Alva, Ignacio Madrazo
Intramedullary hemorrhagic necrosis occurs early after spinal cord injury at the site of injury and adjacent segments. It is considered harmful because of its potential to aggravate secondary injury, and to interfere with axonal regeneration; it might also lead to an unfavorable environment for intralesional implants. Removal of hemorrhagic necrosis has been attempted before with variable results. The invasive nature of these procedures carries the risk of exacerbating damage to the injured cord. The overall objective for this study was to test several strategies for non-damaging removal of hemorrhagic necrosis and characterize the resulting cavity looking for a space for future intralesional therapeutic implants in rats with acute cord injury...
2017: PloS One
L Zhang, W Q Jia, J Yang
Objective: To investigate the clinical features, microsurgical management and outcomes of intramedullary spinal arteriovenous malformations (AVM). Methods: A series of 14 patients (10 male, 4 female; mean age (39.1±17.2) years ranged from 16 to 72 years) with intramedullary spinal AVM who underwent microsurgical treatment from November 2008 to April 2015 in Department of Neurosurgery at Beijing Tiantan Hospital were retrospectively reviewed. The location of the AVM included cervical (n=6), thoracic (n=3), cervicothoracic (n=2), and conus medullaris (n=3)...
December 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Dorota Tassigny, Basel Abu-Serieh, Daniella Tsague Fofe, Jacques Born, Germain Milbouw
BACKGROUND: Syringomyelia is a progressive cerebrospinal fluid disorder that can lead to irreversible spinal cord injury. To date, the optimal management of syringomyelic cavities remains controversial. Multiple studies have emphasized the importance of the craniocervical decompression or shunting procedures; however, except for syrinx related to Chiari malformation, nearly one-half of patients need to undergo reoperation. The purpose of the present study was to describe a simple and efficient surgical technique and to report the long-term radioclinical outcomes...
February 2017: World Neurosurgery
Marcel Ivanov, Alexandru Budu, Hugh Sims-Williams, Ion Poeata
BACKGROUND: Our aim was to evaluate the usefulness of modern intraoperative ultrasonography (iUS) in the resection of a wide variety of spinal intradural pathologic entities. METHODS: We evaluated patients with spinal cord disease treated between January 2006 and September 2015. Intraoperative standard B-mode images were acquired using a 3.5-MHz to 12-MHz ultrasonographic probes (linear and curvilinear) on various ultrasound machines. The benefits and disadvantages of iUS were assessed for each case...
January 2017: World Neurosurgery
Ramesha Papanna, Lovepreet K Mann, Saul Snowise, Yisel Morales, Sanjay P Prabhu, Scheffer C G Tseng, Raymond Grill, Stephen Fletcher, Kenneth J Moise
OBJECTIVES: The objective of our study was to test the hypothesis that in utero repair of surgically created spina bifida in a sheep model using cryopreserved human umbilical cord (HUC) patch improves neurological outcome. METHODS: Spina bifida with myelotomy was surgically created in timed pregnant ewes at gestational day (GD) 75. The fetuses were randomly assigned to unrepaired versus HUC and treated at GD 95 and then delivered at GD 140. Neurological evaluation was performed using the Texas Spinal Cord Injury Scale (TSCIS), bladder control using ultrasound, and the hindbrain herniation...
July 2016: American Journal of Perinatology Reports
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