Multiple Subpial Transections in Eloquent Cortex for Refractory Epilepsy: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E167-E167
Author(s):  
Alexander C Whiting ◽  
Claudio Cavallo ◽  
Nicholas Rubel ◽  
Joshua S Catapano ◽  
Corey T Walker ◽  
...  
Keyword(s):  
Superior Temporal Gyrus ◽  
Neurological Deficits ◽  
Seizure Focus ◽  
Pars Opercularis ◽  
Eloquent Cortex ◽  
Surgical Treatments ◽  
Preoperative Work Up ◽  
Work Up ◽  
Neurologically Intact

Abstract Although the epilepsy refractory to medical therapy can potentially be cured by the resection of epileptogenic tissue, many patients do not qualify for surgery, because epileptogenic tissue can arise from eloquent areas of the brain, where surgical resection would result in severe neurological deficits. Palliative surgical treatments currently used in these situations include deep brain stimulation, responsive neurostimulation, and vagal nerve stimulation.1 A previously developed technique, multiple subpial transections (MSTs), although used infrequently, is another effective tool.2 Our patient, a 34-yr-old man, had epilepsy that was refractory to medical management. His preoperative work-up demonstrated a potential seizure focus in the left pars opercularis and left superior temporal gyrus, which was verified using invasive stereoelectroencephalography. Functional magnetic resonance imaging demonstrated a significant verbal and motor function in this region. After informed consent was obtained, the patient underwent a left-sided craniotomy. The central portion of the seizure focus was resected using the subpial technique. The surrounding presumed epileptogenic cortex, which was considered functionally eloquent, was then horizontally disconnected with MSTs. For each transection, a small puncture incision was made in the pia, and a vertical cut was completed using Morrell dissectors.2 MSTs were performed circumferentially around the entire resection cavity in 5-mm increments. All hemostasis was achieved with irrigation instead of electrocautery, although noncauterizing hemostatic agents are also acceptable. The patient was neurologically intact after the operation and was discharged home on postoperative day 2. He was free of seizures at 11-month follow-up. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Spondylolysis of C-2 in children 3 years of age or younger: clinical presentation, radiographic findings, management, and outcomes with a minimum 12-month follow-up

2014 ◽  
Vol 13 (2) ◽  
pp. 196-203 ◽  
Author(s):  
Loyola V. Gressot ◽  
Sudhakar Vadivelu ◽  
Steven W. Hwang ◽  
Daniel H. Fulkerson ◽  
Thomas G. Luerssen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Young Children ◽  
Neurological Deficits ◽  
Radiographic Findings ◽  
Children's Hospital ◽  
Very Young Children ◽  
The Mean ◽  
Neurologically Intact

Object Cervical spondylolysis is a rare condition that results from a pars interarticularis defect. The C-6 level is the most frequently involved site in the cervical spine. Its clinical presentations range from incidental radiographic findings to neck pain and, rarely, neurological deficits. Although 150 patients with subaxial cervical spondylolysis have been reported, a mere 24 adult and pediatric patients with C-2 spondylolysis have been described. The long-term outcomes of very young children with bilateral C-2 spondylolysis are of great interest, yet only a few longitudinal studies exist. Methods The authors retrospectively reviewed 5 cases of bilateral C-2 spondylolysis at Texas Children's Hospital and Riley Children's Hospital; these were combined with 5 other cases in the literature, yielding a total of 10 patients. Data regarding the patients' age, sex, C2–3 angulation and displacement, associated spine anomalies, neurological deficits, treatment, and most recent follow-up were recorded. Results The patients' ages ranged from 3 to 36 months (mean 12.9 months). There were 6 boys and 4 girls. The C2–3 angulation, displacement, and width of pars defect were measured when available. The mean C2–3 angulation was 9.5° (range 1–34°), the mean C2–3 displacement was 4.78 mm (range 1.1–10.8 mm), and the mean width of the pars defect was 4.16 mm (range 0.9–7 mm). One patient developed myelopathy and spinal cord injury. All 10 of the patients were treated initially with conservative therapy: 3 with close observation alone, 1 with a rigid cervical collar, 4 with a Minerva jacket, 1 with a sternal-occipital-mandibular immobilizer, and 1 with a halo vest. Three patients ultimately underwent surgery for internal fixation due to progressive instability or development of neurological symptoms. All patients were neurologically intact at the last follow-up (mean 44.3 months, range 14–120 months). Conclusions Based on the literature and the authors' own experience, they conclude that most very young children with C-2 spondylolysis remain neurologically intact and maintain stability in long-term follow-up despite the bony defect. This defect is often an asymptomatic incidental finding and may be managed conservatively. More aggressive therapy including surgery is indicated for those patients with a neurological deficit from spinal cord compromise secondary to stenosis and local C-2 kyphosis, progressive deformity, or worsening C2–3 instability.

Preoperative work-up for definition of lymph node risk involvement in early stage endometrial cancer: 5-year follow-up

2017 ◽  
Vol 69 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Pietro Cignini ◽  
Salvatore Giovanni Vitale ◽  
Antonio Simone Laganà ◽  
Antonio Biondi ◽  
Valentina Lucia La Rosa ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Definition Of ◽  
Preoperative Work Up ◽  
Work Up ◽  
Early Stage Endometrial Cancer

Management of Plasmacytomas of the Spine

Neurosurgery ◽  
1983 ◽  
Vol 13 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Christopher M. Loftus ◽  
Christopher B. Michelsen ◽  
Frederick Rapoport ◽  
J. Lobo Antunes
Keyword(s):  
Symptomatic Relief ◽  
Neurological Deficits ◽  
Lumbar Region ◽  
Medical Work ◽  
Systemic Involvement ◽  
Neurological Improvement ◽  
Definition Of ◽  
Work Up

Abstract Epidural plasmacytoma often reflects systemic myelomatous involvement and usually has a poor prognosis. The isolated spinal plasmacytoma, however, is a lesion with the potential for long term remission or even cure in some cases. We report six patients with isolated plasmacytoma of the low thoracic or lumbar region, all of whom presented with pain and minimal neurological deficits. Our approach to such cases included a complete medical work-up and radiographic definition of the lesion with a bone scan, a skeletal survey, myelography, computed tomography, and, in some instances, spinal angiography. All of these patients underwent laminectomy and spinal fusion with autologous bone and harrington rods. There was no morbidity associated with the procedure, which was designed to prevent possible collapse during subsequent radiotherapy or chemotherapy, with its attendant potential for neurological catastrophe. Several patients have developed systemic involvement necessitating chemotherapy, but in follow-up extending now to 4 years all patients remain ambulatory and pain-free. We are encouraged by the potential for symptomatic relief and neurological improvement of patients with isolated spinal plasmacytomas who are treated with an aggressive medical and surgical approach.

Parametrial endometriosis with ureteral involvement: A case report of a conservative approach without ureteral resection

2018 ◽  
Vol 10 (4) ◽  
pp. 222-223 ◽  
Author(s):  
Paolo Donarini ◽  
Giuseppe Ciravolo ◽  
Fabio Rampinelli ◽  
Franco Odicino ◽  
Federico Giorgio Ferrari ◽  
...  
Keyword(s):  
Renal Function ◽  
Uterosacral Ligament ◽  
Deep Infiltrating Endometriosis ◽  
Conservative Approach ◽  
Left Ureter ◽  
Stent Removal ◽  
Preoperative Work Up ◽  
Work Up ◽  
Infiltrating Endometriosis

Introduction: Parametrial endometriosis could often involve the ureter and periureteral tissue causing hydronephrosis and distortion of the normal ureteral course and position. The treatment in the case of hydronephrosis could be ureterolysis (with or without the positioning of a stent) or a ureteral resection. Materials and methods: This is the case of left parametrial endometriosis with hydronephrosis in a young woman. The preoperative work-up showed a deep infiltrating endometriosis of the left parametria, the left uterosacral ligament, and the left ureter which caused hydronephrosis. The patient was symptomatic (dysmenorrhea, dysuria, and pelvic pain). In this video, we focused on ureterolysis: all the endometriotic tissues were removed, the ureter was completely released, and the decision was to place a stent in the ureter without ureteral resection. Results: The post-operative course was normal, the stent was changed after 1 week (from mono-J to double-J) and removed 1 month after surgery. Follow-up at 3 and 8 months after stent removal was normal, and renal function was normal. The last follow-up, after 13 months, showed no hydronephrosis, no signs of deep infiltrating endometriosis, and normal renal function. The patient continues with oral contraception. Conclusion: Ureterolysis could be an effective alternative to ureteral resection in cases of deep infiltrating endometriosis even when the ureter is involved with hydronephrosis.

Multimodality management of Spetzler-Martin Grade III arteriovenous malformations

2012 ◽  
Vol 116 (6) ◽  
pp. 1279-1288 ◽  
Author(s):  
Paritosh Pandey ◽  
Michael P. Marks ◽  
Ciara D. Harraher ◽  
Erick M. Westbroek ◽  
Steven D. Chang ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Neurological Deficits ◽  
Eloquent Cortex ◽  
Type 3 ◽  
Grade Iii

Object Grade III arteriovenous malformations (AVMs) are diverse because of their variations in size (S), location in eloquent cortex (E), and presence of central venous drainage (V). Because they may have implications for management and outcome, the authors evaluated these variations in the present study. Methods Between 1984 and 2010, 100 patients with Grade III AVMs were treated. The AVMs were categorized by Spetzler-Martin characteristics as follows: Type 1 = S1E1V1, Type 2 = S2E1V0, Type 3 = S2E0V1, and Type 4 = S3E0V0. The occurrence of a new neurological deficit, functional status (based on modified Rankin Scale [mRS] score) at discharge and follow-up, and radiological obliteration were correlated with demographic and morphological characteristics. Results One hundred patients (49 female and 51 male; age range 5–68 years, mean 35.8 years) were evaluated. The size of AVMs was less than 3 cm in 28 patients, 3–6 cm in 71, and greater than 6 cm in 1; 86 AVMs were located in eloquent cortex and 38 had central drainage. The AVMs were Type 1 in 28 cases, Type 2 in 60, Type 3 in 11, and Type 4 in 1. The authors performed embolization in 77 patients (175 procedures), surgery in 64 patients (74 surgeries), and radiosurgery in 49 patients (44 primary and 5 postoperative). The mortality rate following the management of these AVMs was 1%. Fourteen patients (14%) had new neurological deficits, with 5 (5%) being disabling (mRS score > 2) and 9 (9%) being nondisabling (mRS score ≤ 2) events. Patients with Type 1 AVMs (small size) had the best outcome, with 1 (3.6%) in 28 having a new neurological deficit, compared with 72 patients with larger AVMs, of whom 13 (18.1%) had a new neurological deficit (p < 0.002). Older age (> 40 years), malformation size > 3 cm, and nonhemorrhagic presentation predicted the occurrence of new deficits (p < 0.002). Sex, eloquent cortex, and venous drainage did not confer any benefit. In 89 cases follow-up was adequate for data to be included in the obliteration analysis. The AVM was obliterated in 78 patients (87.6%), 69 of them (88.5%) demonstrated on angiography and 9 on MRI /MR angiography. There was no difference between obliteration rates between different types of AVMs, size, eloquence, and drainage. Age, sex, and clinical presentation also did not predict obliteration. Conclusions Multimodality management of Grade III AVMs results in a high rate of obliteration, which was not influenced by size, venous drainage, or eloquent location. However, the development of new neurological deficits did correlate with size, whereas eloquence and venous drainage did not affect the neurological complication rate. The authors propose subclassifying the Grade III AVMs according to their size (< 3 and ≥ 3 cm) to account for treatment risk.

scholarly journals Post-Covid tracheal resection – first case in India

2022 ◽  
Vol 7 (4) ◽  
pp. 123-125
Author(s):  
Anjoo A. Choudhary ◽  
Kamruddin K. Ezzy ◽  
Supriya V. Jadhav
Keyword(s):  
Complete Loss ◽  
Tracheal Resection ◽  
Prolonged Intubation ◽  
First Case ◽  
Resection And Anastomosis ◽  
Preoperative Work Up ◽  
Work Up ◽  
Loss Of Voice

Prolonged intubations result in tracheal damage and stenosis, the treatment for severe cases is resection and anastomosis. With the progress of the Covid-19 pandemic, this incidence kept rising but the timing and precautions for such aerosolising surgeries remained unclear. To report the first case of tracheal resection and anastomosis in India done during the Covid-19 pandemic along with its rationale. We report a case of 30/male with prolonged intubation and tracheostomy done for Covid-19 pneumonia and ARDS with failure to decannulate and complete loss of voice. After thorough preoperative work-up, he underwent tracheal resection of 4 rings with cricotracheal anastomosis during the covid-19 pandemic in October 2020. He was extubated on table and was asymptomatic after 3 months of follow-up with excellent voice. With good team effort and appropriate precautions, aerosolising airway surgeries resection anastomosis can be safely performed.

scholarly journals A Concomitant Occurrence of the Atlantoaxial Subluxation with Rare Vertebral Formation and Segmentation Defects

2021 ◽  
Vol 64 (5) ◽  
pp. 837-842
Author(s):  
Man Kyu Choi ◽  
Sung Bum Kim ◽  
Jun Ho Lee
Keyword(s):  
Vertebral Body ◽  
Congenital Anomalies ◽  
Clinical Signs ◽  
Atlantoaxial Subluxation ◽  
Neurological Deficits ◽  
Os Odontoideum ◽  
Vertebral Bodies ◽  
Multi Level ◽  
Preoperative Work Up ◽  
Work Up

An atlantoaxial subluxation from the unstable Os odontoideum by the failure of proper integrations between the embryological somites might be a commonly reported pathology. However, its suspicious origin or paralleled occurrence with other congenital anomalies of vertebral body might be a relatively rare phenomenon. The authors present two cases, who simply presented with clinical signs of prolonged, intractable cervicalgia without any neurological deficits, revealed this rare feature of C1–2 subluxation from the unstable, orthotropic type of Os odontoideum that coincide with congenitally fused cervical vertebral bodies between C2–3. Surprisingly, in one case, when traced from the lower cervical down to the thoracic-lumbar levels during the preoperative work-up process, was also compromised with multi-level butterfly vertebrae formations. Presented cases highlight the association of various congenital vertebrae anomalies and the rationale to fuse only affected joints.

Avulsion Fracture of the Foramen Magnum Treated with Occiput-to-C1 Fusion: Technical Case Report

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. E600-E600 ◽  
Author(s):  
Peter H. Maughan ◽  
Eric M. Horn ◽  
Nicholas Theodore ◽  
Iman Feiz-Erfan ◽  
Volker K.H. Sonntag
Keyword(s):  
Avulsion Fracture ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Rare Injury ◽  
Computed Tomographic ◽  
Inferior Aspect ◽  
Lateral Mass Screws ◽  
Occipital Condyles ◽  
Neurologically Intact

ABSTRACT OBJECTIVE AND IMPORTANCE: A 31-year-old woman presented with an avulsion fracture of the foramen magnum via bilateral occipital condyles with extension through the inferior aspect of the clivus. CLINICAL PRESENTATION: The patient had no neurological deficits and was initially immobilized in a halo brace. INTERVENTION: To preserve rotational motion at C1–C2, we performed an occiput-to-C1 fusion with bilateral C1 lateral mass screws attached with rods to occipital keel screws. Postoperatively, the patient remained neurologically intact. Three-month follow-up imaging revealed no abnormal motion. Follow-up computed tomographic scan showed an intact construct and bony fusion. CONCLUSION: This rare injury, a bony variant of occipitoatlantal dislocation, was successfully treated with a unique occiput-to-C1 fusion.

scholarly journals The role of intraoperative MRI in resective epilepsy surgery for peri-eloquent cortex cortical dysplasias and heterotopias in pediatric patients

2016 ◽  
Vol 40 (3) ◽  
pp. E16 ◽  
Author(s):  
Matthew F. Sacino ◽  
Cheng-Ying Ho ◽  
Jonathan Murnick ◽  
Robert F. Keating ◽  
William D. Gaillard ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Neurological Deficit ◽  
Pediatric Patients ◽  
Neurological Deficits ◽  
Seizure Freedom ◽  
Resection Group ◽  
Eloquent Cortex ◽  
Postoperative Seizure

OBJECTIVE Previous studies have demonstrated that an important factor in seizure freedom following surgery for lesional epilepsy in the peri-eloquent cortex is completeness of resection. However, aggressive resection of epileptic tissue localized to this region must be balanced with the competing objective of retaining postoperative neurological functioning. The objective of this study was to investigate the role of intraoperative MRI (iMRI) as a complement to existing epilepsy protocol techniques and to compare rates of seizure freedom and neurological deficit in pediatric patients undergoing resection of perieloquent lesions. METHODS The authors retrospectively reviewed the medical records of pediatric patients who underwent resection of focal cortical dysplasia (FCD) or heterotopia localized to eloquent cortex regions at the Children's National Health System between March 2005 and August 2015. Patients were grouped into two categories depending on whether they underwent conventional resection (n = 18) or iMRI-assisted resection (n = 11). Patient records were reviewed for factors including demographics, length of hospitalization, postoperative seizure freedom, postoperative neurological deficit, and need for reoperation. Postsurgical seizure outcome was assessed at the last postoperative follow-up evaluation using the Engel Epilepsy Surgery Outcome Scale. RESULTS At the time of the last postoperative follow-up examination, 9 (82%) of the 11 patients in the iMRI resection group were seizure free (Engel Class I), compared with 7 (39%) of the 18 patients in the control resection group (p = 0.05). Ten (91%) of the 11 patients in the iMRI cohort achieved gross-total resection (GTR), compared with 8 (44%) of 18 patients in the conventional resection cohort (p = 0.02). One patient in the iMRI-assisted resection group underwent successful reoperation at a later date for residual dysplasia, compared with 7 patients in the conventional resection cohort (with 2/7 achieving complete resection). Four (36%) of the patients in the iMRI cohort developed postoperative neurological deficits, compared with 15 patients (83%) in the conventional resection cohort (p = 0.02). CONCLUSIONS These results suggest that in comparison with a conventional surgical protocol and technique for resection of epileptic lesions in peri-eloquent cortex, the incorporation of iMRI led to elevated rates of GTR and postoperative seizure freedom. Furthermore, this study suggests that iMRI-assisted surgeries are associated with a reduction in neurological deficits due to intraoperative damage of eloquent cortex.

scholarly journals A study of pediatric cerebral arteriovenous malformations: clinical presentation, radiological features, and long-term functional and educational outcomes with predictors of sustained neurological deficits

2019 ◽  
Vol 24 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Robert J. Bollo ◽  
Ilyas M. Eli ◽  
Julius Griauzde ◽  
Arianna Lanpher ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Neurological Deficit ◽  
Functional Outcomes ◽  
Arteriovenous Malformations ◽  
Pediatric Patients ◽  
Neurological Deficits ◽  
Long Term Follow Up ◽  
Eloquent Cortex

OBJECTIVELarge experiences with the treatment of pediatric arteriovenous malformations (AVMs) remain relatively rare, with limited data on presentation, treatment, and long-term functional outcomes. Because of the expected long lifespan of children, caregivers are especially interested in outcome measures that assess quality of life. The authors’ intention was to describe the long-term functional outcomes of pediatric patients who undergo AVM surgery and to identify predictors of sustained neurological deficits.METHODSThe authors analyzed a 21-year retrospective cohort of pediatric patients with intracranial AVMs treated with microsurgery at two institutions. The primary outcome was a persistent neurological deficit at last follow-up. Secondary outcome measures included modified Rankin Scale (mRS) score and independent living.RESULTSOverall, 97 patients (mean age 11.1 ± 4.5 years; 56% female) were treated surgically for intracranial AVMs (mean follow-up 77.5 months). Sixty-four patients (66%) presented with hemorrhage, and 45 patients (46%) had neurological deficits at presentation. Radiologically, 39% of lesions were Spetzler-Martin grade II. Thirty-seven patients (38%) with persistent neurological deficits at last follow-up were compared with those without deficits; there were no differences in patient age, presenting Glasgow Coma Scale score, AVM size, surgical blood loss, or duration of follow-up. Multivariate analysis demonstrated that a focal neurological deficit on presentation, AVM size > 3 cm, and lesions in eloquent cortex were independent predictors of persistent neurological deficits at long-term follow-up. Overall, 92% of the children had an mRS score ≤ 2 on long-term follow-up.CONCLUSIONSPediatric patients with AVMs treated with microsurgical resection have good functional and radiological outcomes. There is a high rate (38%) of persistent neurological deficits, which were independently predicted by preoperative deficits, AVMs > 3 cm, and lesions located in eloquent cortex. This information can be useful in counseling families on the likelihood of long-term neurological deficits after cerebral AVM surgery.

Sign in / Sign up

Export Citation Format

Share Document