Entrapment of the C2 Root and Ganglion by the Atlanto-Epistrophic Ligament: Clinical Syndrome and Surgical Anatomy

Neurosurgery ◽  
1990 ◽  
Vol 27 (2) ◽  
pp. 288-291 ◽  
Author(s):  
Charles E. Poletti ◽  
William H. Sweet
Keyword(s):  
Clinical Syndrome ◽  
Surgical Anatomy ◽  
Surgical Decompression ◽  
Sensory Function ◽  
Sensory Deficit ◽  
Normal Anatomy ◽  
Lancinating Pain

Abstract Two cases of progressive, occipital lancinating pain and dysesthesias associated with a sensory deficit of the C2 dermatome are presented. Symptoms were relieved, and C2 sensory function restored by releasing a hypertrophied atlanto-epistrophic ligament entrapping the C2 root and ganglion. The normal anatomy and abnormal surgical findings are described. C2 entrapment by the atlanto-epistrophic ligament is discussed in reference to other C2 lesions causing occipital pain. We conclude that some patients whose progressive occipital pain is accompanied by a C2 sensory deficit are suffering from entrapment of the C2 root and ganglion amenable to surgical decompression.

Complete Bilateral Brachial Plexus Injury from Rhabdomyolysis and Compartment Syndrome: Surgical Case Report

2018 ◽  
Vol 17 (2) ◽  
pp. E68-E72 ◽  
Author(s):  
Daniel A Tonetti ◽  
Ivan S Tarkin ◽  
Kiran Bandi ◽  
John J Moossy
Keyword(s):  
Brachial Plexus ◽  
Compartment Syndrome ◽  
Clinical Presentation ◽  
Brachial Plexus Injury ◽  
Laboratory Data ◽  
Surgical Decompression ◽  
Sensory Function ◽  
Resonance Imaging ◽  
Pectoralis Muscles ◽  
Prolonged Immobilization

Abstract BACKGROUND AND IMPORTANCE Acute bilateral brachial plexus injury is rare and usually a result of traction injury. Immediate operative intervention is reserved for rare cases of ongoing compression of the plexus; the role for acute decompression of the brachial plexus secondary to compartment syndrome has not been previously described. In this report, we describe the technique and role for urgent brachial plexus decompression. CLINICAL PRESENTATION A 32-yr-old man presented with acute complete bilateral brachial plexus palsy due to focal rhabdomyolysis and brachial plexus compression after a night of excess alcohol and methadone ingestion. He had complete loss of motor and sensory function from C5 to T1, with the exception of partial sensory sparing of the C5 dermatome. Magnetic resonance imaging demonstrated diffuse muscular edema of the supraclavicular and infraclavicular fossae in addition to the pectoralis muscles and the deltoids bilaterally. He underwent urgent surgical decompression of his supraclavicular and infraclavicular fossae with fasciotomies of the pectoral muscles and the anterior deltoids, allowing direct visualization and decompression of the entire brachial plexus resulting in a near-complete functional recovery. CONCLUSION Neurosurgeons should include brachial plexus compression due to compartment syndrome in the differential diagnosis of patients with acute upper extremity weakness, particularly when associated with prolonged immobilization and/or substance abuse. Prompt surgical decompression should be performed in these patients if imaging and laboratory data suggest compartment syndrome and resultant neurological deficit.

scholarly journals Anatomical variations of the phrenic nerve: an actualized review

2015 ◽  
Vol 32 (01) ◽  
pp. 053-056 ◽  
Author(s):  
A. Prates Júnior ◽  
L. Vasques ◽  
L. Bordoni
Keyword(s):  
Subclavian Artery ◽  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Internal Thoracic Artery ◽  
Anatomical Variations ◽  
Surgical Anatomy ◽  
Diaphragm Muscle ◽  
Normal Anatomy ◽  
The Subject ◽  
Superior Portion

Abstract Introduction: The phrenic nerve normally arises from ventral rami of C3, C4 and C5. It emerges laterally to the superior portion oflateral border of scalenus anterior muscle and presents a descendent course between subclavian artery and vein. It crosses anterior to internal thoracic artery and descends through the mediastinum, until the diaphragm muscle, to supply it with motor and sensitive fibers. Matherials and Methods: A bibliographic review was conducted, based on anatomy, neuroanatomy and surgical anatomy textbooks, published in Brazil and abroad, as well as a review of scientific articles, published over the last 20 years, available on research databases PubMed, Scielo, LILACS and MEDLINE, from keywords phrenic nerve, variation and anomaly. Results: Variations of the phrenic nerve are frequent, but they are not often discussed. Thus, we aimed to conduct an actualized review over the subject. Regarding the variations in the origin of the phrenic nerve, textbooks vaguely inform that it is mainly formed by C4, but the recent cadaveric studies pointed the segments C4 and C5 as the most common origin. About the variations in its course, the most described is its passage anterior to the subclavian vein, before reaching the thorax. However, the presence of accessory phrenic nerve represents the greatestvariation, mostly arising from nerve to subclavian. There are few reports in literature about the complications associated to these variations, but some are suggested, as the possibility of causing its damage during the puncture of the subclavian vein, when the nerve descends anterior to it, which may lead to a hemidiaphragmatic paresis. When variations are present, even simple procedures may cause injuries. Conclusion: Therefore it is fundamental to know the normal anatomy and the possible variations of the phrenic nerve, in order to perform safe procedures in its topography, as well as to enable a timely recognition of complications.

scholarly journals Multidisciplinary Management of Pituitary Apoplexy

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Adriana Albani ◽  
Francesco Ferraù ◽  
Filippo Flavio Angileri ◽  
Felice Esposito ◽  
Francesca Granata ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Pituitary Gland ◽  
Multidisciplinary Approach ◽  
Pituitary Apoplexy ◽  
Clinical Syndrome ◽  
Surgical Decompression ◽  
Medical Emergency ◽  
Multidisciplinary Management ◽  
Pituitary Tumours ◽  
Haemorrhagic Necrosis

Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2–12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team’s skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention.

NEUROPATHIC PAIN IN BRACHIAL PLEXUS INJURY

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 39-45 ◽  
Author(s):  
Direk Tantigate ◽  
Saichol Wongtrakul ◽  
Torpon Vathana ◽  
Roongsak Limthongthang ◽  
Panupan Songcharoen
Keyword(s):  
Neuropathic Pain ◽  
Brachial Plexus ◽  
Upper Extremity ◽  
Brachial Plexus Injury ◽  
Traumatic Injury ◽  
Demographic Characteristics ◽  
Sensory Function ◽  
Sensory Deficit ◽  
Injured Patients

Background: In Thailand, brachial plexus injury is a common traumatic injury that affects the function of the upper extremity. The current treatments focus mainly on improving the motor and sensory function. Apart from the motor and sensory deficit, these patients usually suffer from pain. Objective: The purpose of this study was to determine the prevalence and factors that relate to neuropathic pain in patients with brachial plexus injury. Methods: We collected data from March 2008 to July 2011. The DN4 Questionnaire was used to diagnose neuropathic pain in 95 patients. Results: The prevalence of neuropathic pain was as high as 76%. Majority of patients presented with hypoesthesia to pin prick, hypoesthesia to touch and numbness. Severity of neuropathic pain was significantly correlated with the type of brachial plexus injury. There was no difference between demographic characteristics of patients. Conclusion: Our study showed that the prevalence of neuropathic pain was high in brachial plexus injured patients. Therefore, surgeons should be aware of this common, yet underestimated, problem in brachial plexus injured patients.

Postcraniotomy Pain and Chiari Malformation Pain

2018 ◽  
Author(s):  
Andrew Wuenstel ◽  
David Frim ◽  
Magdalena Anitescu
Keyword(s):  
Chiari Malformation ◽  
Interventional Therapy ◽  
Clinical Syndrome ◽  
Surgical Decompression ◽  
Common Symptom ◽  
Adult Women ◽  
Management Options ◽  
Pain Syndromes ◽  
Occipital Headache

The clinical syndrome associated with Chiari malformation type 1 (CM1) affects all ages, newborns through elderly. Boys and girls are affected equally; adult women are affected three times more than men. The most common form of Chiari malformation, CM1, is often asymptomatic, but one common symptom of CM1 is occipital headache triggered by Valsalva maneuvers. A syrinx, present in many patients, causes neurologic deficits at the level of the syrinx or below. There are medical and surgical management options to treat the pain syndromes associated with CM1. For patients who are resistant to medical and interventional therapy after surgical decompression, few efficacious treatments are available to relieve chronic postoperative, postcraniotomy pain.

Dural Plasmacytoma

Neurosurgery ◽  
1983 ◽  
Vol 12 (5) ◽  
pp. 576-579 ◽  
Author(s):  
Paul B. Pritchard ◽  
Robert A. Martinez ◽  
Douglas G. Hungerford ◽  
James M. Powers ◽  
Phanor L. Perot
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Immunoglobulin G ◽  
Unique Feature ◽  
Local Treatment ◽  
Clinical Findings ◽  
Clinical Syndrome ◽  
Surgical Decompression ◽  
Tentorium Cerebelli ◽  
Neurological Signs

Abstract Dural plasmacytoma is an unusual form of myeloma. We describe a woman with plasmacytoma of the tentorium cerebelli that was managed successfully with surgical decompression and radiotherapy. Computed tomography, not previously reported in cases of dural plasmacytoma, was useful in her management. Another unique feature was the restoration of a normal immunoglobulin G content in the blood and cerebrospinal fluid after local treatment of the neoplasm. Two previously reported cases showed similar normalization of cerebrospinal fluid immunoglobulin G after local radiotherapy. Dural plasmacytoma presents a characteristic clinical syndrome. The typical patient is a woman (92% of the reported cases) in the 5th decade of life. Clinical findings reflect intracranial hypertension, often with focal neurological signs, consistent with the usual dural or tentorial origin of the tumor. Immunoglobulin abnormalities may be found in serum or cerebrospinal fluid. The prognosis is good after surgical decompression and local radiotherapy.

scholarly journals DIFFERENTIAL SURGICAL TREATMENT OF CERVICAL SPINE STENOSIS

2006 ◽  
pp. 047-054
Author(s):  
Artyom Olegovich Gushcha ◽  
Ivan Nikolayevich Shevelev ◽  
Aleksandr Romanovich Shakhnovich ◽  
Vadim Aleksandrovich Safronov ◽  
Sergey Olegovich Arestov
Keyword(s):  
Cervical Spine ◽  
Morphological Changes ◽  
Clinical Manifestations ◽  
Minimal Invasive ◽  
Clinical Syndrome ◽  
Surgical Decompression ◽  
Conduction Time ◽  
Ischemic Lesion ◽  
Segmental Artery ◽  
Vertebral Artery Compression

Objectives. To determine the efficacy of various procedures of precise differentiated surgical decompression for elimination of prevailing clinical manifestations of degenerative stenosis depending on a character and localization of morphological changes (degenerative or posttraumatic) in the cervical spine, the expediency and necessity of application of various fixation and stabilization techniques. Material and Methods. Eighteen patients included in the study were examined for degenerative stenosis in the cervical spine. All of them underwent decompressive surgery. International representative scales were used to estimate results depending on basic clinical syndrome. Results. The increase in latency and central sensory conduction time (according to somatosensory evoked potentials data) indicates that ischemic compression lesion is mainly caused by dorsal compression. In this case a laminectomy according to Hirabayashi was performed. The increase in central motor latency time (according to central transcranial magnetic stimulation) greater by 30 % than a norm indicates that ischemic lesion is caused by anterior vertebral artery compression. In this case a corporectomy was performed. Conclusion. Compression lesions in cervical spine stenosis have local ischemic character and correspond to blood supply basin of compromised spinal or segmental artery. There is a correlation of ischemic compression focus localization with a character of electrophysiological conduction and responses. Differential character of surgical decompression provides observation of minimal invasive principles and better neurological restoration of patients.

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