La RM nelle sequele dei traumi spinali

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 192-195 ◽  
Author(s):  
G. Pellicanò ◽  
G. Caracchini ◽  
M. D'Andrea ◽  
M. Bartolucci ◽  
I. Del Seppia ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Acute Phase ◽  
Vertebral Body ◽  
Neurological Symptoms ◽  
Spinal Cord Lesions ◽  
Guided Surgery ◽  
Thoracic Level ◽  
Post Traumatic

From January 1990 to April 1997 we retrospectively evaluated 90 patients with MR examinations at our Spine Unit. The following post-traumatic spinal cord lesions were diagnosed: atrophy (47 pts), myelomalacia (40 pts), cysts (14), syrinx (14) and medullary transection with adhesion(4 pts). MR was very useful to identify atrophy more frequently found at the cervical-thoracic level (C6-D3). Myelomalcia was found in a patient with severe vertebral body trauma with chronic compression of the spinal cord. Intramedullary cysts were found in patients with hematomyelia in acute phase and were stable lesions. Post-traumatic syringomyelia is the most important sequela due to the fact that is often correlated with symptoms. MR not only detected the lesion but also identified intramedullary cavities without new neurological symptoms and guided surgery and follow-up. MR is the examination of choice not only for diagnosis of chronic spinal cord lesions but also to evaluate the possibility of surgical treatment.

scholarly journals Intradural ventral and ventrolateral tumors of the spinal cord: surgical treatment and results

2004 ◽  
Vol 17 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Eugene I. Slin'ko ◽  
Iyad Ischak Al-Qashqish
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Malignant Tumors ◽  
Clinical Results ◽  
Neurological Symptoms ◽  
Surgical Approaches ◽  
Intradural Extramedullary

Object To improve results of surgical treatment of ventral and ventrolateral tumors of the spinal cord, the authors analyzed surgical approaches, defined the indications for various approaches, and assessed the clinical results. Methods Between 1993 and 2004 the authors treated 360 patients: 43 of them had dorsal, 177 dorsolateral, 33 ventral, and 107 had ventrolateral intradural extramedullary tumors. Among 140 patients with intradural extramedullary ventral and ventrolateral tumors, neuromas were seen in 56 and meningiomas in 84. Of the 140 patients studied, tumors were removed totally in 102 (74%), subtotally in 30 (21%), and partially in eight (5%). After ventrolateral and dorsolateral approaches were introduced in 1996, tumors in ventral or ventrolateral locations have been removed totally or subtotally. In the group of patients with meningiomas, 41 of the lesions were the meningothelial type, 22 were transitional, 12 fibroblastic, four psammomatous, three were angiomatous, one was atypical, and one was malignant. Tumors in the neuroma group were schwannomas in 45 patients and neurofibromas in 11. Postoperatively, recovery was observed in 70 patients (50%), improvement in 53 (38%), no change in 10 (7%), and deterioration in seven (5%). At follow-up evaluation recovery was noted in 76 patients, improvement in 58, no change in four, and in two patients the neurological symptoms were worse than before the operation. Conclusions Surgical routes to extramedullary tumors should be chosen based on the location of the tumor, its spread, and the region in which it is localized.

Hypogastric Artery Stenting for Chronic Intermittent Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 27 (5) ◽  
pp. 801-804
Author(s):  
Catharina Gronert ◽  
Nikolaos Tsilimparis ◽  
Giuseppe Panuccio ◽  
Ahmed Eleshra ◽  
Fiona Rohlffs ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Neurological Symptoms ◽  
Endovascular Aortic Repair ◽  
Hypogastric Artery ◽  
Lower Extremity Weakness ◽  
Aortic Repair ◽  
The Right

Purpose: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting. Case Report: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA. Conclusion: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.

scholarly journals Treatment of Injuries of the Lumbar Spine

2019 ◽  
Vol 5 (12) ◽  
pp. 156-162
Author(s):  
M. Sabyraliev
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Spinal Canal ◽  
Thoracolumbar Spine ◽  
Spinal Injuries ◽  
Long Term Results ◽  
Results Of Treatment ◽  
Post Traumatic

Surgical treatment of patients with spinal injuries, accompanied by traumatic stenosis of the spinal canal, is an urgent and discussed problem of modern vertebrology. Surgical treatment of 111 patients with various injuries of the thoracolumbar spine was performed. In 40 patients, post-traumatic stenosis was eliminated using ligamentotaxis using transpedicular osteosynthesis. The immediate results of treatment were followed up in all patients: good results were obtained in 33 (82.5%) cases; satisfactory — in 6 (15.0%), unsatisfactory — in 1 (2.5%). Long-term results with a follow-up of more than 1 year were followed up in 27 (67.5%) patients; good results were obtained in 20 (74.0%), satisfactory in 7 (25.0%).

scholarly journals An analysis of the causes of transient paraplegia during percutaneous vertebral augmentation under local anesthesia: A case series of 12 patients

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986187
Author(s):  
Guan Shi ◽  
Fei Feng ◽  
Chen Hao ◽  
Jia Pu ◽  
Bao Li ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Local Anesthesia ◽  
Vertebral Body ◽  
Case Series ◽  
Operation Time ◽  
Complete Recovery ◽  
Vertebral Compression Fractures ◽  
Vertebral Augmentation ◽  
Anesthetic Drugs

Background: Percutaneous vertebral augmentation (PVA) under local anesthesia has been widely used to treat osteoporotic vertebral compression fractures and vertebral body tumors. However, the occurrence of spinal cord or nerve root dysfunction may result in poor prognosis for patients. The aim of this study was to analyze the causes of transient paraplegia in 12 patients undergoing PVA. Methods: The medical records of 12 patients with transient paraplegia during PVA in our hospital were analyzed. Data, including operation, vertebral, anesthetic dose, operation time, recovery time, and follow-up, were extracted. Results: Among the 12 patients, ranging in age from 62 years to 83 years, with a mean age of 74 years, 8 were females and 4 were males. The average anesthetic dose injected per vertebral body was 6.38 ml. Patients required an average of 218.75 min to recover sensation and movement completely. However, the amount of anesthetic injected into each vertebral body was not related to the time required for complete recovery. Follow-up showed that all patients had regained normal bilateral sensation and motor function. Postoperative visual analog scale and Oswestry Disability Index values of the 12 patients were significantly improved compared with preoperative values. Conclusion: The complication of transient paraplegia was caused by local anesthetic drugs infiltrating into the spinal canal and inhibiting nerve conduction in the spinal cord.

scholarly journals Surgical Outcomes in Post-Traumatic Epilepsy: A Single Institutional Experience

2019 ◽  
Vol 18 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Frederick L Hitti ◽  
Matthew Piazza ◽  
Saurabh Sinha ◽  
Svetlana Kvint ◽  
Eric Hudgins ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Seizure Frequency ◽  
Surgical Outcomes ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Post Traumatic ◽  
Neocortical Epilepsy ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

Abstract BACKGROUND Post-traumatic epilepsy (PTE) is a debilitating sequela of traumatic brain injury (TBI), occurring in up to 20% of severe cases. This entity is generally thought to be more difficult to treat with surgical intervention. OBJECTIVE To detail our experience with the surgical treatment of PTE. METHODS Patients with a history of head injury undergoing surgical treatment for epilepsy were retrospectively enrolled. Engel classification at the last follow-up was used to assess outcome of patients that underwent surgical resection of an epileptic focus. Reduction in seizure frequency was assessed for patients who underwent vagal nerve stimulator (VNS) or responsive neurostimulator (RNS) implantation. RESULTS A total of 23 patients met inclusion criteria. Nineteen (82.6%) had mesial temporal sclerosis, 3 had lesional neocortical epilepsy (13.0%), and 1 had nonlesional neocortical epilepsy (4.3%). Fourteen patients (60.9%) underwent temporal lobectomy (TL), 2 underwent resection of a cortical focus (8.7%), and 7 underwent VNS implantation (30.4%). Three patients underwent RNS implantation after VNS failed to reduce seizure frequency more than 50%. In the patients treated with resection, 11 (68.8%) were Engel I, 3 (18.8%) were Engel II, and 2 (12.5%) were Engel III at follow-up. Average seizure frequency reduction in the VNS group was 30.6% ± 25.6%. RNS patients had reduction of seizure severity but seizure frequency was only reduced 9.6% ± 13.6%. CONCLUSION Surgical outcomes of PTE patients treated with TL were similar to reported surgical outcomes of patients with nontraumatic epilepsy treated with TL. Patients who were not candidates for resection demonstrated variable response rates to VNS or RNS implantation.

scholarly journals Surgical Treatment of Vascular Intramedullary Spinal Cord Lesions

Cureus ◽  
2018 ◽  
Author(s):  
George M Ghobrial ◽  
Jason Liounakos ◽  
Robert M Starke ◽  
Allan D Levi
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Spinal Cord Lesions ◽  
Intramedullary Spinal Cord

scholarly journals Thoracic Vertebral Hemangioma with Spinal Cord Compression: Multidisciplinary Surgical Treatment and Follow-up of Six Patients

2016 ◽  
Vol 8 (4) ◽  
pp. 462-467 ◽  
Author(s):  
Hui-lin Zhang ◽  
Yong-cheng Hu ◽  
Rajendra Aryal ◽  
Xin He ◽  
Deng-xing Lun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Vertebral Hemangioma

scholarly journals Bleeding Pseudocyst of the Pancreatic Head. The role of Omentoplasty and Local Hemostasis

HPB Surgery ◽  
1994 ◽  
Vol 8 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Francesco Stipa ◽  
Adolfo Gavelli ◽  
Claude Huguet
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Pancreatic Resection ◽  
Pancreatic Head ◽  
Postoperative Mortality ◽  
Arterial Embolization ◽  
Arterial Ligation ◽  
Post Traumatic

Treatment of bleeding psedoaneurysms and pseudocysts of the pancreas is controversial. Surgical treatment with pancreatic resection or trancystic arterial ligation is not always satisfactory since postoperative mortality rate is high, especially for lesions located in the pancreatic head and rebleeding is not unusual. Two patients with bleeding pseudoaneurysms (one post traumatic, one spontaneous) and one with a hemorrhagic pseudocyst of the pancreatic head were treated surgically with arterial suture and omentoplasty. Bleeding was controlled in all, without any postoperative mortality or morbidity. No rebleeding occurred with a follow up of 33, 26 and 12 months. Trancystic ligation of bleeding vessels with omentoplasty may be a useful approach, which should be compared to arterial embolization in the future.

Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment

2012 ◽  
Vol 16 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Masatoshi Sumi ◽  
Hiroshi Miyamoto ◽  
Teppei Suzuki ◽  
Shuichi Kaneyama ◽  
Takako Kanatani ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Mr Imaging ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Rank Test ◽  
Imaging Findings ◽  
Significant Difference ◽  
The Mean

Object Because the main pathology of cervical spondylotic myelopathy (CSM) is spinal cord damage due to compression, surgical treatment is usually recommended to improve patient symptoms and prevent exacerbation. However, lack of clarity of prognosis in cases that present with insignificant symptoms, particularly those of mild CSM, lead one to question the veracity of this course of action. The purpose of this study was to elucidate the prognosis of mild CSM without surgical intervention by evaluation of clinical symptoms and MR imaging findings. Methods Sixty cases of mild CSM (42 males and 18 females, average age 57.2 years) presenting with scores of 13 or higher on the Japanese Orthopaedic Association (JOA) scale were treated initially by in-bed Good Samaritan cervical traction without surgery. These patients were enrolled between 1995 and 2003 and followed up periodically until the date of myelopathy deterioration or until the end of March 2009. The deterioration of myelopathy was defined as a decline in JOA score to less than 13 with a decrease of at least 2 points. As a prognostic factor, the authors used their classification of spinal cord shapes at their lateral sides on axial T1-weighted MR imaging. “Ovoid deformity” was classified as a situation in which both sides were round and convex, and “angular-edged deformity” where one or both sides exhibited an acute-angled lateral corner. The duration of follow-up was assessed as the tolerance rate of mild CSM using Kaplan-Meier survival analysis and compared between 2 groups classified by MR imaging findings. Furthermore, differences between groups were analyzed by various applications of the log-rank test. Results Of the initial 60 cases, follow-up records existed for 55, giving a follow-up rate of 91.7% (38 males and 17 females, average age 56.1 years). The mean JOA score at end point was 14.1, which was not statistically different from the mean of 14.5 at the initial visit. Deterioration in myelopathy was observed in 14 (25.5%) of 55 cases, whereas 41 (74.5%) of 55 cases maintained mild extent myelopathy without deterioration through the follow-up period (mean 94.3 months). The total tolerance rate of mild CSM was 70%. However, there was a significant difference in the tolerance rate between the cases with angular-edged deformity (58%) and cases with ovoid deformity (95%; p = 0.049). Conclusions The tolerance rate of mild CSM was 70% in this study, which proved that the prognosis of mild CSM without surgical treatment was relatively good. However, the tolerance rate of the cases with angular-edged deformity was 58%. Therefore, surgical treatment should be considered when mild CSM cases show angular-edged deformity on axial MR imaging, even if patients lack significant symptoms.

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