Just the Tip: Resection of a Narcotic Catheter-Tip Granuloma: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (2) ◽  
pp. E52-E52 ◽  
Author(s):  
Joanna Elizabeth Gernsback ◽  
John Paul G Kolcun ◽  
Glen Manzano
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Inflammatory Mass ◽  
Opioid Dose ◽  
Neurologic Deficits ◽  
Minimal Improvement ◽  
Catheter Tip ◽  
Catheter Replacement

Abstract The catheter tip “granuloma” is a rare inflammatory mass that forms in about 3% of patients with an intradural catheter, most commonly from a morphine pump. It has also been seen with other narcotic pumps, narcotic-non-narcotic combinations, and baclofen pumps. Mass formation is associated with increased opioid dose and concentration. It typically presents with increasing pain requiring increasing doses of medication, with minimal improvement, although it may present with neurologic deficits or be asymptomatic. On MRI, it appears as a round, rim-enhancing lesion that is low intensity with a hypointense rim on both T1 and T2. In the absence of neurologic deficits, there are many treatment options, ranging from a temporary stopping of the pump to catheter replacement. When the lesion presents with neurologic deficits, surgical intervention, beyond catheter replacement or repositioning, is indicated. A laminectomy is performed, with intradural exploration and careful resection of the mass, which is likely adherent to the spinal cord. Postoperative worsening of symptoms is common due to the mass being densely adherent to the spinal cord, requiring spinal cord manipulation. This worsening is usually temporary, and many patients make excellent recoveries. We present a case of a hydromorphone pump inflammatory mass, which initially presented with increasing pain, then progressive neurologic deficits, requiring referral and mass resection. We achieved only a partial resection due to the lesion's adherent nature. This surgical video demonstrates our intradural technique for resection of this rare and technically difficult mass, with 6-mo patient follow-up. The patient has consented to this case report.

Motor network recovery in patients with chronic spinal cord compression: a longitudinal study following decompression surgery

2018 ◽  
Vol 28 (4) ◽  
pp. 379-388 ◽  
Author(s):  
Kayla Ryan ◽  
Sandy Goncalves ◽  
Robert Bartha ◽  
Neil Duggal
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Surgical Intervention ◽  
Blood Oxygen Level Dependent ◽  
Cord Compression ◽  
Decompression Surgery ◽  
Blood Oxygen Level ◽  
Motor Network ◽  
Dependent Signal

OBJECTIVEThe authors used functional MRI to assess cortical reorganization of the motor network after chronic spinal cord compression and to characterize the plasticity that occurs following surgical intervention.METHODSA 3-T MRI scanner was used to acquire functional images of the brain in 22 patients with reversible cervical spinal cord compression and 10 control subjects. Controls performed a finger-tapping task on 3 different occasions (baseline, 6-week follow-up, and 6-month follow-up), whereas patients performed the identical task before surgery and again 6 weeks and 6 months after spinal decompression surgery.RESULTSAfter surgical intervention, an increased percentage blood oxygen level–dependent signal and volume of activation was observed within the contralateral and ipsilateral motor network. The volume of activation of the contralateral primary motor cortex was associated with functional measures both at baseline (r = 0.55, p < 0.01) and 6 months after surgery (r = 0.55, p < 0.01). The percentage blood oxygen level–dependent signal of the ipsilateral supplementary motor area 6 months after surgery was associated with increased function 6 months after surgery (r = 0.48, p < 0.01).CONCLUSIONSPlasticity of the contralateral and ipsilateral motor network plays complementary roles in maintaining neurological function in patients with spinal cord compression and may be critical in the recovery phase following surgery.

Shunting with gravitational valves—can adjustments end the era of revisions for overdrainage-related events?

2012 ◽  
Vol 117 (6) ◽  
pp. 1197-1204 ◽  
Author(s):  
Florian Baptist Freimann ◽  
Christian Sprung
Keyword(s):  
Unsolved Problem ◽  
Surgical Intervention ◽  
Statistical Significance ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Opening Pressure ◽  
Shunt Insertion ◽  
New Generation ◽  
Valve Pressure

Object Overdrainage of CSF remains an unsolved problem in shunt therapy. The aim of the present study was to evaluate treatment options on overdrainage-related events enabled by the new generation of adjustable gravity-assisted valves. Methods The authors retrospectively studied the clinical course of 250 consecutive adult patients with various etiologies of hydrocephalus after shunt insertion for different signs and symptoms of overdrainage. Primary and secondary overdrainage were differentiated. The authors correlated the incidence of overdrainage with etiology of hydrocephalus, opening valve pressure, and patient parameters such as weight and size. Depending on the severity of overdrainage, they elevated the opening pressure, and follow-up was performed until overdrainage was resolved. Results The authors found 39 cases (15.6%) involving overdrainage-related problems—23 primary and 16 secondary overdrainage. The median follow-up period in these 39 patients was 2.1 years. There was no correlation between the incidence of overdrainage and any of the following factors: sex, age, size, or weight of the patients. There was also no statistical significance among the different etiologies of hydrocephalus, with the exception of congenital hydrocephalus. All of the “complications” could be resolved by readjusting the opening pressure of the valve in one or multiple steps, avoiding further operations. Conclusions Modern adjustable and gravity-assisted valves enable surgeons to set the opening pressure relatively low to avoid underdrainage without significantly raising the incidence of overdrainage and to treat overdrainage-related clinical and radiological complications without surgical intervention.

scholarly journals Pre-interruptive intracoronal resorption: clinical and radiographic follow-up

2017 ◽  
Vol 65 (3) ◽  
pp. 282-285 ◽  
Author(s):  
Sâmila Gonçalves BARRA ◽  
Maria Isabel de Oliveira e Brito VILLALOBOS ◽  
Cláudia Valéria de Sousa Resende PENIDO ◽  
Angela Christina Barroso RECCHIONI ◽  
Maria Augusta Portella Guedes VISCONTI
Keyword(s):  
Surgical Intervention ◽  
Treatment Options ◽  
Panoramic Radiograph ◽  
Conservative Approach ◽  
Dental Clinic ◽  
Routine Examination ◽  
Caucasian Girl ◽  
Radiolucent Lesion ◽  
Unerupted Teeth

ABSTRACT Pre-interruptive intracoronal resorption is a radiolucent lesion localized in dentin, immediately below the amelodentin junction of unerupted teeth. It is rare, asymptomatic, and of idiopathic etiology, generally diagnosed in routine radiographs or in those for orthodontic purposes. A conservative approach, with radiographic follow-up is the treatment recommended until the tooth erupts, and then the intervention is made. However, in cases with symptoms or progression of the lesion, surgical intervention is advisable. To report a case of pre-interruptive intracoronal resorption, with a conservative approach, showing the clinical and radiographic follow-up of this condition. The patient, a nine-year-old Caucasian girl, presented to the Dental Clinic for routine examination. An initial panoramic radiograph was requested, which showed an intracoronal radiolucence in tooth 45 that had not yet erupted. Clinical and radiographic follow-up was made until the affected tooth was completely established in the oral cavity. The treatment recommended for pre-interruptive intracoronal resorption is to have knowledge of the phenomenon, associate its probable etiology and radiographic aspect, as well as its prevalence, occurrence and treatment options, by considering a conservative approach when there are no symptoms.

Syrinx reduction due to spontaneous spinal cord tear: demonstration on 3 T MRI and review of the literature

2021 ◽  
Vol 14 (12) ◽  
pp. e246235
Author(s):  
Serena Staglianó ◽  
Elena Prodi ◽  
Barbara Goeggel Simonetti ◽  
Alessandro Cianfoni
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Adult Population ◽  
Paediatric Population ◽  
Review Of The Literature ◽  
Thoracic Level ◽  
High Resolution Mri ◽  
Upper Thoracic ◽  
Serial Mri

A holocord syringomyelia due to Chiari 1.5 malformation (CM) in a 12-year-old girl was serially imaged with 3 T MRI over 4 years. The serial MRI showed reduction in size of the syrinx, without any surgical intervention or CM improvement, but rather due to spontaneous spinal cord tear. The tear was clearly demonstrated by evidence of flow signal across the tear between syrinx and subarachnoid space at the upper thoracic level. The tear showed spontaneous closure at follow-up. A medullary tear has been described in the adult population as one of the putative causes of spontaneous syringomyelia reduction, but its clear demonstration with modern high-resolution MRI has not been reported in the paediatric population. Moreover, this is the first reported case of syrinx reduction due to spontaneous fissuration in a paediatric patient.

scholarly journals Treatment options and time course for intramedullary spinal cord metastasis Report of three cases and review of the literature

1998 ◽  
Vol 4 (5) ◽  
pp. E5 ◽  
Author(s):  
Bernhard Sutter ◽  
Adam Arthur ◽  
Jeffrey Laurent ◽  
James Chadduck ◽  
Gerhard Friehs ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Natural History ◽  
Time Course ◽  
Surgical Intervention ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Review Of The Literature ◽  
Intramedullary Spinal Cord ◽  
History Of ◽  
Intramedullary Spinal Cord Metastasis

Surgical treatment of intrameduallary spinal cord metastases (ISCM) has become increasingly effective in recent years. The advent of new imaging techniques combined with an enhanced understanding of the natural history of these tumors has improved the effectiveness of the available treatment options. The authors present three new cases of ISCM successfully treated with surgery. A review of 129 cases found in the literature is also discussed. Characteristic symptomology and presentation are reviewed with an eye toward improving diagnostic methodology. The natural history of ISCM is divided into three phases. Surgical intervention should be used early in phase 2.

Effect of Surgical Intervention on Neurologic Recovery in Patients with Central Cord Syndrome

2020 ◽  
Vol 81 (04) ◽  
pp. 318-323
Author(s):  
Li Du ◽  
Shichang Zhao ◽  
Zhongsheng Zhu ◽  
Feng Xue ◽  
Yadong Zhang
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Perioperative Complications ◽  
Spinal Instability ◽  
Indications For Surgery ◽  
Neurologic Recovery ◽  
Central Cord Syndrome ◽  
Time Of Admission ◽  
Better Than

AbstractTo review the experience of managing central cord syndrome (CCS) surgically, we retrospectively reviewed 71 patients from October 2015 to April 2017. Deteriorating neurologic status with evidence of radiologic compression and spinal instability were absolute indications for surgery. The American Spinal and Injury Association (ASIA) motor scores (AMS) were recorded at the time of admission (aAMS), 3 days postoperatively (3dAMS), 1 month postoperatively(1mAMS), and at final follow-up (fAMS). Analysis of variance was performed to compare 3dAMS, 1mAMS, and fAMS. Surgery was successful in all 71 patients without re-injury of the spinal cord, infection, or other perioperative complications. The postoperative AMS at 3 days, 1 month, and at the final follow-up significantly improved over preoperative scores. ASIA sensory scores at fAMS were significantly better than 3dAMS and1mAMS scores. The ASIA motor and sensory scores at 1mAMS showed no significant improvements compared with the 3dAMS. Therefore, for patients diagnosed with CCS, combined with evidence of radiologic compression and spinal instability, surgery was beneficial in terms of gains in neurologic recovery.

scholarly journals 15 YEARS OF PARAGANGLIOMA: Imaging and imaging-based treatment of pheochromocytoma and paraganglioma

2015 ◽  
Vol 22 (4) ◽  
pp. T135-T145 ◽  
Author(s):  
Frédéric Castinetti ◽  
Alexander Kroiss ◽  
Rakesh Kumar ◽  
Karel Pacak ◽  
David Taieb
Keyword(s):  
Functional Imaging ◽  
Surgical Intervention ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Review Article ◽  
Whole Body ◽  
Anatomical Imaging ◽  
Imaging Algorithms ◽  
Near Future

Although anatomic imaging to assess the precise localization of pheochromocytomas/paragangliomas (PHEOs/PGLs) is unavoidable before any surgical intervention on these tumors, functional imaging is becoming an inseparable portion of the imaging algorithm for these tumors. This review article presents applications of the most up-to-date functional imaging modalities and image-based treatment to PHEOs/PGLs patients. Functional imaging techniques provide whole-body localization (number of tumors present along with metastatic deposits) together with genetic-specific imaging approaches to PHEOs/PGLs, thus enabling highly specific and sensitive PHEO/PGL detection and delineation that now greatly impact the management of patients. Radionuclide imaging techniques also play a crucial role in the prediction of possible radioactive treatment options for PHEO/PGL. In contrast to previous imaging algorithms used for either assessement of these patients or their follow-up, endocrinologists, surgeons, oncologists, pediatricians, and other specialists require functional imaging before any therapeutic plan is outlined to the patient, and follow-up, especially in patients with metastatic disease, is based on the periodic use of functional imaging, often reducing or substituting for anatomical imaging. In similar specific indications, this will be further powered by using PET/MR in the assessment of these tumors. In the near future, it is expected that PHEO/PGL patients will benefit even more from an assessement of the functional characteristics of these tumors and new imaging-based treatment options. Finally, due to the use of new targeting moieties, gene-targeted radiotherapeutics and nanobodies-based theranostic approaches are expected to become a reality in the near future.

scholarly journals Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI): an overview of initial enrollment and demographics

2020 ◽  
Vol 48 (5) ◽  
pp. E6 ◽  
Author(s):  
Rachel E. Tsolinas ◽  
John F. Burke ◽  
Anthony M. DiGiorgio ◽  
Leigh H. Thomas ◽  
Xuan Duong-Fernandez ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Treatment Options ◽  
Clinical Information ◽  
Surgical Approaches ◽  
Clinical Knowledge ◽  
Common Data Elements ◽  
New Therapeutic Approaches ◽  
Cord Injury

OBJECTIVETraumatic spinal cord injury (SCI) is a dreaded condition that can lead to paralysis and severe disability. With few treatment options available for patients who have suffered from SCI, it is important to develop prospective databases to standardize data collection in order to develop new therapeutic approaches and guidelines. Here, the authors present an overview of their multicenter, prospective, observational patient registry, Transforming Research and Clinical Knowledge in SCI (TRACK-SCI).METHODSData were collected using the National Institute of Neurological Disorders and Stroke (NINDS) common data elements (CDEs). Highly granular clinical information, in addition to standardized imaging, biospecimen, and follow-up data, were included in the registry. Surgical approaches were determined by the surgeon treating each patient; however, they were carefully documented and compared within and across study sites. Follow-up visits were scheduled for 6 and 12 months after injury.RESULTSOne hundred sixty patients were enrolled in the TRACK-SCI study. In this overview, basic clinical, imaging, neurological severity, and follow-up data on these patients are presented. Overall, 78.8% of the patients were determined to be surgical candidates and underwent spinal decompression and/or stabilization. Follow-up rates to date at 6 and 12 months are 45% and 36.3%, respectively. Overall resources required for clinical research coordination are also discussed.CONCLUSIONSThe authors established the feasibility of SCI CDE implementation in a multicenter, prospective observational study. Through the application of standardized SCI CDEs and expansion of future multicenter collaborations, they hope to advance SCI research and improve treatment.

scholarly journals Systemic juvenile xanthogranuloma: a case of spontaneous regression of intramedullary spinal cord, cerebral, and cutaneous lesions

2017 ◽  
Vol 20 (6) ◽  
pp. 556-560
Author(s):  
Anne Morice ◽  
Sylvie Fraitag ◽  
Catherine Miquel ◽  
Christian Sainte Rose ◽  
Stéphanie Puget
Keyword(s):  
Spinal Cord ◽  
Treatment Options ◽  
Multidisciplinary Care ◽  
Benign Disease ◽  
Juvenile Xanthogranuloma ◽  
Cutaneous Lesions ◽  
Intramedullary Spinal Cord ◽  
First Case

Juvenile xanthogranuloma (JXG) is a rare disease that belongs to the non-Langerhans cell histiocytoses. It presents a wide clinical spectrum, usually occurs before 5 years of age, and is commonly confined to the skin; however, it can affect multiple sites, including the nervous system, and can lead to severe disorders. Although JXG is a benign disease that usually regresses spontaneously, several curative treatments have been proposed in cases of organ involvement. Treatment options include corticosteroids, chemotherapy, and radiotherapy; however, these can have severe, long-term adverse effects in children.The authors here describe the first case of spontaneous resolution of an intramedullary spinal cord lesion of JXG associated with cerebral and cutaneous lesions in a young boy with 9 years of follow-up. The initial neurological symptoms resolved without any surgical or medical treatment. This case shows that extracutaneous lesions of JXG, including those with intramedullary spinal cord involvement, can regress without curative treatment—like cutaneous lesions—although both multidisciplinary care and close follow-up should be implemented.

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