Minimally Invasive Endoscopic Aspiration of a Spinal Epidural Dermoid Cyst Extending From T10 to the Sacrum: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (5) ◽  
pp. E172-E172
Author(s):  
Charles V Hatchette ◽  
Salah G Aoun ◽  
Tarek Y El Ahmadieh ◽  
Lauren Smalley ◽  
Ankur R Patel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Dermoid Cyst ◽  
Complex Disease ◽  
Interdisciplinary Cooperation ◽  
Conus Medullaris ◽  
Tumor Burden ◽  
Neurological Function ◽  
Ethical Review ◽  
University Of Texas ◽  
Patient Consent

Abstract Dermoid cysts are space-occupying tumors that can occur anywhere in the neuroaxis. Although categorized as benign lesions, they can compromise normal structures, causing neurological function loss, and have a tendency to recur often requiring repeated surgical resections. We illustrate the case of an extensive epidural dermoid cyst in a 22-yr-old woman who presented with progressive loss of neurological motor function in her lower extremities as well as bowel and bladder incontinence. The tumor extended from T10 to the sacrum, and a conventional operation would have entailed serial laminectomies that would cross the thoracolumbar and lumbosacral junctions, possibly requiring an instrumented fusion. Given the fact that operation would have carried significant morbidity, especially with the high likelihood of symptomatic tumoral recurrence, we consulted with our urology colleagues to find a minimally invasive way of reducing the tumor burden and decompressing the neural elements. The patient was taken to the operating room and a limited open lumbosacral durotomy was performed. A flexible cystoscope was then passed in the epidural space and used to suction the tumor. Postoperative imaging showed adequate resection, and the patient recovered neurological function completely. She had mini-mal recurrence at 3 yr and remained asymptomatic. This technical video note showcases the potential for use of endoscopy for spine tumors that have an amenable consistency, even in highly eloquent areas such as the conus medullaris. It also serves to highlight the benefits of interdisciplinary cooperation when treating complex disease. This case report was written in compliance with our institutional ethical review board. Institutional Review Board (IRB) approval and patient consent was waived in light of the retrospective and deidentified nature of the data presented in accordance with the University of Texas SouthWestern IRB. Patient consent was waived for writing this manuscript in light of the retrospective and deidentified nature of the data presented in accordance with our institutional IRB.

Bertolotti Syndrome With Articulated L5 Transverse Process Causing Intractable Back Pain: Surgical Video Showcasing a Minimally Invasive Approach for Disconnection: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Zachary D Johnson ◽  
Salah G Aoun ◽  
Vin Shen Ban ◽  
Tarek Y E l Ahmadieh ◽  
Benjamin Kafka ◽  
...  
Keyword(s):  
Back Pain ◽  
Minimally Invasive ◽  
Clinical Symptoms ◽  
Symptomatic Relief ◽  
Transverse Process ◽  
Ethical Review ◽  
Invasive Approach ◽  
University Of Texas ◽  
Institutional Review ◽  
Patient Consent

Abstract Bertolotti syndrome is a commonly missed cause of intractable back pain that affects 4% to 8% of the general population. It involves the congenital malformation of a transitional lumbosacral vertebra, with total or partial and unilateral or bilateral transverse process (TP) fusion or articulation to the sacrum. The pain can be debilitating, and the tethering of the spine to the sacrum can encourage deformity formation in the coronal plane and lead to early degenerative changes, especially if present only unilaterally. We present the case of a 24-yr-old woman with no notable prior medical history who presented with years of lower axial back pain radiating to her thighs, which limited her activities of daily living and was resistant to conservative management. Her imaging showed an abnormally large left L5 TP, which was articulated to the sacrum, and signs of early coronal deformity. She had responded almost completely to repeated steroid injections into the TP-sacral joint, but that effect was very transient. Informed patient consent was obtained prior to her surgery. She underwent a minimally invasive tube disconnection of the abnormal joint with partial distal resection of the TP, and her symptoms completely resolved. This case highlights the importance of correlating clinical symptoms with aberrant anatomy, and the role of selective surgery in providing symptomatic relief. This case report was written in compliance with our institutional ethical review board approval, and patient consent was waived in light of the retrospective and deidentified nature of the data presented in accordance with the University of Texas Southwestern institutional review board.

Retrieval of an Intracranially Migrated Dental Injection Needle Through the Foramen Ovale: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E168-E168 ◽  
Author(s):  
Salah G Aoun ◽  
Tarek Y El Ahmadieh ◽  
Vin Shen Ban ◽  
Vishal J Patel ◽  
Awais Vance ◽  
...  
Keyword(s):  
Trigeminal Nerve ◽  
Rare Complication ◽  
Middle Cranial Fossa ◽  
Ethical Review ◽  
Foramen Ovale ◽  
University Of Texas ◽  
Injection Needle ◽  
Facial Musculature ◽  
Patient Consent ◽  
The Right

Abstract Dental injection needle migration is a rare complication of orthodontal procedures. When these needles fracture, they typically dislodge into the cervical space or the facial musculature. Migration into the cranial vault is difficult because of the obstacle created by the skull base. We report a rare case of intracranial migration of an anesthetic injection needle through the foramen ovale. A 59-yr-old man underwent the extraction of a right maxillary molar. The distal end of a 25-gauge injection needle broke into his pterygoid musculature, causing him pain while chewing. Vascular imaging obtained after a computed tomography scan of his face showed that the needle had migrated, potentially because of his efforts of mastication, and had traversed the foramen ovale into the middle cranial fossa. The patient started experiencing intermittent right facial numbness, likely due to compression or injury to the right trigeminal nerve. Our oral and maxillofacial colleagues did not believe that the needle could be retrieved from its facial end. The patient elected to undergo the recovery of the needle through a craniotomy given the fact that the object was contaminated and because he was becoming increasingly symptomatic. A right pterional craniotomy was planned. Extradural dissection was performed until the dura going into the foramen ovale was revealed. We could feel the metallic needle under the dural sheath of the trigeminal nerve. The dura was opened sharply directly over the needle. We then proceeded to mobilize the needle into the face, and then pulled it out completely through the craniotomy to avoid injury to the temporal lobe. The patient recovered well and was asymptomatic at the time of discharge. This case report was written in compliance with our institutional ethical review board. Institutional review board (IRB) approval and patient consent were waived in light of the retrospective and deidentified nature of the data presented in accordance with the University of Texas Southwestern (UTSW) IRB.

Ruptured dermoid cyst of the conus medullaris in the myelomeningocele sac revealed at the initial repair surgery

2019 ◽  
Vol 36 (5) ◽  
pp. 1061-1065 ◽  
Author(s):  
Ai Kurogi ◽  
Takato Morioka ◽  
Nobuya Murakami ◽  
Naoyuki Nakanami ◽  
Satoshi O. Suzuki
Keyword(s):  
Dermoid Cyst ◽  
Conus Medullaris

Congenital Dermal Sinus Elements in Each Tethering Stalk of Coexisting Thoracic Limited Dorsal Myeloschisis and Retained Medullary Cord

2020 ◽  
pp. 1-8
Author(s):  
Takato Morioka ◽  
Nobuya Murakami ◽  
Masako Ichiyama ◽  
Takeshi Kusuda ◽  
Satoshi O. Suzuki
Keyword(s):  
Present Article ◽  
Dermoid Cyst ◽  
Spinal Dysraphism ◽  
Conus Medullaris ◽  
Dermal Sinus ◽  
Case Presentation ◽  
Upper Tract ◽  
Secondary Neurulation ◽  
Extradural Space ◽  
Congenital Dermal Sinus

<b><i>Introduction:</i></b> The embryogenesis of limited dorsal myeloschisis (LDM) likely involves impaired disjunction between the cutaneous and neural ectoderms during primary neurulation. Because LDM and congenital dermal sinus (CDS) have a shared origin in this regard, CDS elements can be found in the LDM stalk. Retained medullary cord (RMC) is a closed spinal dysraphism involving a robust, elongated, cord-like structure extending from the conus medullaris to the dural cul-de-sac. Because the RMC is assumed to be caused by impaired secondary neurulation, concurrent RMC and CDS cannot be explained embryologically. In the present article, we report a case in which CDS elements were noted in each tethering stalk of a coexisting LDM and RMC. <b><i>Case Presentation:</i></b> A 2.5-month-old boy with left clubfoot and frequent urinary and fecal leakage had 2 tethering tracts. The upper tract, which ran from the thoracic tail-like cutaneous appendage, had CDS elements in the extradural stalk and a tiny dermoid cyst in the intradural stalk immediately after the dural entry. In the lower tract, which ran from the lumbosacral dimple, the CDS as an extradural stalk continued to the RMC at the dural cul-de-sac. Both stalks were entirely resected through skip laminotomy/laminectomy at 1 stage to untether the cord and resect the CDS elements. <b><i>Conclusion:</i></b> Surgeons should be aware that CDS elements, in addition to LDM, may coexist with RMC that extends out to the extradural space.

scholarly journals Ruptured Conus Medullaris Dermoid Cyst with Fat Droplets in the Central

2013 ◽  
Vol 7 (1) ◽  
pp. 50 ◽  
Author(s):  
Mayur Sharma ◽  
Rahul Mally ◽  
Vernon Velho
Keyword(s):  
Dermoid Cyst ◽  
Conus Medullaris

scholarly journals Variability between Clarke's angle and Chippaux-Smirak index for the diagnosis of flat feet

2017 ◽  
pp. 25-31 ◽  
Author(s):  
Cristina González Martín ◽  
Salvador Pita Fernández ◽  
Teresa Seoane Pillado ◽  
Beatriz López Calviño ◽  
Sonia Pertega Díaz ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Intraclass Correlation ◽  
Population Sample ◽  
Age Groups ◽  
Independent Effect ◽  
Ethical Review ◽  
Comorbidity Score ◽  
Flat Feet ◽  
Patient Consent ◽  
Foot Arch

Background The measurements used in diagnosing biomechanical pathologies vary greatly. The aim of this study was to determine the concordance between Clarke’s angle and Chippaux-Smirak index, and to determine the validity of Clarke’s angle using the Chippaux-Smirak index as a reference. Methods Observational study in a random population sample (n=1002) in A Coruña (Spain). After informed patient consent and ethical review approval, a study was conducted of anthropometric variables, Charlson comorbidity score, and podiatric examination. Descriptive analysis and multivariate logistic regression were performed. Results The prevalence of flat feet, using a podoscope, was 19.0% for the left foot and 18.9% for the right foot, increasing with age. The prevalence of flat feet according to the Chippaux-Smirak index or Clarke’s angle increases significantly, reaching 62.0% and 29.7% respectively. The concordance (kappa I) between the indices according to age groups varied between 0.25–0.33 (left foot) and 0.21–0.30 (right foot). The intraclass correlation coefficient (ICC) between the Chippaux-Smirak index and Clarke’s angle was -0.445 (left foot) and -0.424 (right foot). After adjusting for age, body mass index (BMI), comorbidity score and gender, the only variable with an independent effect to predict discordance was the BMI (OR=0.969; 95% CI:0.94-0.998). Conclusion There is little concordance between the indices studied for the purpose of diagnosing foot arch pathologies. In turn, Clarke’s angle has a limited sensitivity in diagnosing flat feet, using the Chippaux-Smirak index as a reference. This discordance decreases with higher BMI values.

Ten-Step Minimally Invasive Treatment of Lumbar Giant Disc Herniation via Unilateral Tubular Laminotomy for Bilateral Decompression: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Sertac Kirnaz ◽  
Gary Kocharian ◽  
Fabian Sommer ◽  
Lynn B McGrath ◽  
Jacob L Goldberg ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Disc Herniation ◽  
Spinal Canal ◽  
Lumbar Disc ◽  
Treatment Options ◽  
Modified Technique ◽  
Invasive Treatment ◽  
Interlaminar Approach ◽  
Patient Consent ◽  
Over The Top

Abstract Giant disc herniation (GDH) is generally defined as a lumbar disc herniation that obstructs 50% or more of the space in the spinal canal.1-3 Common treatment options for GDH include unilateral interlaminar approach, bilateral approach, or open full laminectomy.4,5 Surgical treatment of GDH may be challenging because severe bilateral compression of neural elements in the spinal canal increases the risk of iatrogenic injury to nerve roots and dura. The surgical approach can be further complicated by calcification, hardening, and dehydration of the GDH tissue. The prevailing opinion in the literature is that giant disc herniations cannot safely be treated via tubular minimally invasive approaches.5-7 In this video, we present a case of a 52-yr-old male patient with a history of progressive low back pain that radiates bilaterally from the buttocks toward the posterior legs and knees for 2 yr because of a GDH at the L4-5 level. The patient was treated via a tubular “over-the-top” minimally invasive decompression in order to first provide generous bilateral decompression of neural elements and dura.8,9 After sufficient decompression at the surgical level, the discectomy was performed via an ipsilateral piecemeal resection of the GDH. The “over-the-top” contralateral mobilization of disc herniation was also achieved with this approach, which facilitated the removal of the entire disc fragment. Patient consent was obtained prior to performing the procedure. Therefore, GDH should not be considered as a contraindication for tubular decompression when this modified technique is performed.

scholarly journals Ruptured Dermoid Cyst in the Conus Medullaris Detected by Susceptibility Weighted Imaging of the Brain

2015 ◽  
Vol 33 (4) ◽  
pp. 352-354
Author(s):  
Jee Hun Baek ◽  
Se Won Oh ◽  
Won Kyong Bae ◽  
Jai-Joon Shim ◽  
Dae Seop Shin ◽  
...  
Keyword(s):  
Dermoid Cyst ◽  
Conus Medullaris ◽  
Susceptibility Weighted Imaging ◽  
The Brain

Minimally Invasive Tubular Separation Surgery for Metastatic Spinal Cord Compression: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Rafael De la Garza Ramos ◽  
Murray Echt ◽  
Yaroslav Gelfand ◽  
Vijay Yanamadala ◽  
Reza Yassari
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Sensory Level ◽  
Safe Delivery ◽  
Stereotactic Body Radiation ◽  
Patient Consent

Abstract Symptomatic cord compression affects approximately 20% of patients with spinal metastatic disease. Direct decompressive surgery followed by conventional radiation was shown to be superior to radiation alone in a landmark trial published in 2005.1 For radioresistant tumors causing high-grade compression, however, “separation surgery” followed by stereotactic body radiation therapy was developed. The main goal of this newer technique is to decompress and create a distance between the spinal cord and tumor to allow for safe delivery of radiation.2 This technique has shown to provide durable local tumor control, pain relief, and preservation of neurological function.3,4 In this study, we describe a minimally invasive tubular separation surgery technique used to treat symptomatic cord compression in a 59-yr-old man with metastatic prostate adenocarcinoma to T9. The patient presented with acute motor weakness and sensory level. A tubular retraction system was used to dock over the pedicle at T9 bilaterally and a posterior decompression with ligamentectomy was first performed. This was followed by transpedicular decompression and ventral removal of the posterior longitudinal ligament. Space was created between the ventral tumor and spinal cord to allow for postoperative stereotactic body radiation. The patient had a significant improvement in his strength and gait postoperatively.  Patient consent was obtained for videotaping prior to surgical intervention.

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