Use of Actuator-Driven Pulsed Water Jet in Brain and Spinal Cord Cavernous Malformations Resection

Abstract BACKGROUND A piezo actuator-driven pulsed water jet (ADPJ) system is a novel surgical instrument that enables dissection of tissue without thermal damage. It can potentially resect intra-axial lesions while preserving neurological function. OBJECTIVE To report our first experience of applying an ADPJ system to brain and spinal cord cavernous malformations. METHODS Four patients (2 women and 2 men, mean age 44.5 years) with brain (n = 3) and spinal cord (n = 1) cavernous malformations were enrolled in the study. All surgeries were performed with the aid of the ADPJ system. Postoperative neurological function and radiological findings were evaluated. RESULTS The ADPJ system was useful in dissecting boundaries between the lesion and surrounding brain/spinal cord tissues. The pulsed water jet provided a clear surgical view and helped surgeons follow the margins. Water jet dissection peeled off the brain and spinal cord tissues from the lesion wall. Surrounding gliotic tissue was preserved. As a consequence, the cavernous malformations were successfully removed. Postoperative magnetic resonance imaging confirmed total removal of lesions in all cases. Preoperative neurological symptoms completely resolved in 2 patients. The others experienced partial recovery. No patients developed new postoperative neurological deficits; facial palsy temporarily worsened in 1 patient who underwent a suprafacial colliculus approach for the brainstem lesion. CONCLUSION The ADPJ provided a clear surgical field and enabled surgeons to dissect boundaries between lesions and surrounding brain and spinal cord gliotic tissue. The ADPJ system is a feasible option for cavernous malformation surgery, enabling successful tumor removal and preservation of neurological function.

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Widespread central nervous system cavernous malformations associated with café-au-lait skin lesions

Journal of Neurosurgery ◽

10.3171/jns.2003.99.2.0412 ◽

2003 ◽

Vol 99 (2) ◽

pp. 412-415 ◽

Cited By ~ 8

Author(s):

Kiran Musunuru ◽

Virany Huynh Hillard ◽

Raj Murali

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Novel Mutation ◽

Skin Lesions ◽

Neurological Deficits ◽

Intramedullary Spinal Cord ◽

Cavernous Malformations ◽

Content Type ◽

Brain And Spinal Cord

✓ The simultaneous presence of cavernous malformations in the brain and spinal cord is a very rare finding and is typically associated with familial cavernous malformations. Although they are uncommon, various skin lesions can manifest in patients with familial cavernous malformations. The authors report on a 60-year-old man in whom more than 100 lesions consistent in appearance with cavernous malformations, including several intramedullary spinal cord lesions, were found throughout the neuraxis. This patient also displayed prominent café-au-lait skin lesions, but had no additional signs of neurofibromatosis or other neurocutaneous disorders. Analysis of his DNA revealed a novel mutation in the KRIT1/CCM1 gene, thereby confirming the diagnosis of familial cavernous malformation. The presence of these lesions in every major compartment of this patient's central nervous system underscores their indiscriminate nature and the need to screen throughout the neuraxis in patients in whom familial cavernous malformations are suspected. The findings in this case add to the growing list of skin lesions associated with genetically confirmed familial cavernous malformations. In patients presenting with seizures, focal neurological deficits, or hemorrhagic stroke, the presence of unusual skin lesions should prompt consideration of familial cavernous malformations, and appropriate screening should be performed.

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β-Mannosidosis: Myelin and oligodendrocyte lesions in brain and spinal cord

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100113354 ◽

1984 ◽

Vol 42 ◽

pp. 694-695

Author(s):

Kathryn L. Lovell ◽

Margaret Z. Jones

Keyword(s):

Spinal Cord ◽

Nervous System ◽

Genetic Disorder ◽

Neurological Deficits ◽

Axonal Spheroids ◽

South Wales ◽

Pendular Nystagmus ◽

Myelin Deficits ◽

Recessive Defect ◽

Brain And Spinal Cord

Caprine β-mannosidosis, an autosomal recessive defect of glycoprotein catabolism, is associated with a deficiency of tissue and plasma -mannosidase and with tissue accumulation and urinary excretion of oligosaccharides, including the trisaccharide Man(β1-4)GlcNAc(βl-4)GlcNAc and the disaccharide Man(β1-4)GlcNAc. This genetic disorder is evident at birth, with severe neurological deficits including a marked intention tremor, pendular nystagmus, ataxia and inability to stand. Major pathological characteristics described in Nubian goats in Michigan and in Anglo-Nubian goats in New South Wales include widespread cytoplasmic vacuolation in the nervous system and viscera, axonal spheroids, and severe myelin paucity in the brain but not spinal cord or peripheral nerves. Light microscopic examination revealed marked regional variation in the severity of central nervous system myelin deficits, with some brain areas showing nearly complete absence of myelin and other regions characterized by the presence of 25-50% of the control number of myelin sheaths.

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New Application of Actuator-Driven Pulsed Water Jet for Spinal Cord Dissection: An Experimental Study in Pigs

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0036-1584919 ◽

2016 ◽

Vol 78 (02) ◽

pp. 137-143

Author(s):

Jia Wenting ◽

Atsuhiro Nakagawa ◽

Hidenori Endo ◽

Yuto Sagae ◽

Masaki Iwasaki ◽

...

Keyword(s):

Spinal Cord ◽

Experimental Study ◽

Water Jet ◽

Pulsed Water Jet

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Contrasting Actions of Naloxone in Experimental Spinal Cord Trauma and Cerebral Ischemia: A Review

Neurosurgery ◽

10.1227/00006123-198511000-00023 ◽

1985 ◽

Vol 17 (5) ◽

pp. 845-849 ◽

Cited By ~ 12

Author(s):

Allan J. Hamilton ◽

Peter McL. Black ◽

Daniel B. Carr

Keyword(s):

Spinal Cord ◽

Cerebral Ischemia ◽

Opiate Receptor ◽

Neurological Function ◽

Neurological Deficits ◽

Spinal Cord Trauma ◽

Cardiovascular Parameters ◽

Naloxone Administration ◽

Therapeutic Implications ◽

Cord Injury

Abstract Endorphins have been implicated in the pathophysiology of both spinal cord injury and cerebral ischemia. This review examines the nature of the experimental evidence to support this hypothesis. Present studies suggest that naloxone administration improves neurological function and outcome in the setting of the spinal cord trauma by centrally inhibiting an opiate receptor-mediated diminution of spinal cord flow. In the setting of spinal shock, naloxone administration is associated with improvement in vital sign and cardiovascular parameters as measured by mean arterial pressure, cardiac output, body temperature, and ventilation. Experiments using a variety of animal stroke models similarly support the notion that naloxone improves neurological function in the setting of cerebral ischemia by a stereospecific opiate receptor-mediated effect, but this improvement does not seem to be accompanied by augmentation of blood flow to affected areas of the brain or by any improvement in vital signs or cardiovascular parameters as seen in spinal cord trauma. A variety of mechanisms are discussed to explain these observations. The therapeutic implications of administering opiate agonists and antagonists in the setting of neurological deficits are outlined for the neurosurgeon.

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Cavernous Malformations of the Brain and Spinal Cord

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2009.05155.x ◽

2009 ◽

Vol 79 (12) ◽

pp. 953-953

Author(s):

John D. Laidlaw

Keyword(s):

Spinal Cord ◽

Cavernous Malformations ◽

Brain And Spinal Cord ◽

The Brain

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Neurological function after total en bloc spondylectomy for thoracic spinal tumors

Journal of Neurosurgery Spine ◽

10.3171/2009.9.spine09506 ◽

2010 ◽

Vol 12 (3) ◽

pp. 253-256 ◽

Cited By ~ 27

Author(s):

Hideki Murakami ◽

Norio Kawahara ◽

Satoru Demura ◽

Satoshi Kato ◽

Katsuhito Yoshioka ◽

...

Keyword(s):

Spinal Cord ◽

Neurological Function ◽

Neurological Symptoms ◽

Neurological Deficits ◽

Spinal Tumors ◽

Preoperative Embolization ◽

Spinal Cord Blood Flow ◽

Thoracic Spinal ◽

Bloc Spondylectomy ◽

Frankel Grade

Object Total en bloc spondylectomy (TES) for thoracic spinal tumors may in theory produce neurological dysfunction as a result of ischemic or mechanical damage to the spinal cord. Potential insults include preoperative embolization at 3 levels, intraoperative ligation of segmental arteries, nerve root ligation, and circumferential dural dissection. The purpose of this study was to assess neurological function after thoracic TES. Methods The authors performed a retrospective review of 79 patients with thoracic-level spinal tumors that had been treated with TES between 1989 and 2006. Neurological function was retrospectively analyzed according to the Frankel grading system. Of the 79 cases, 26 involved primary tumors and 53 involved metastatic tumors. The number of excised vertebrae was 1 in 60 cases, 2 in 13, and ≥ 3 in 6. The Frankel grade before surgery was B in 1 case, C in 16, D in 29, and E in 33. Results At the follow-up, the Frankel grade was C in 2 cases, D in 24, and E in 53. Of 46 cases with neurological deficits before surgery, neurological improvement of at least 1 Frankel grade was achieved in 25 cases (54.3%). Although the Frankel grade did not change in 21 patients, improvement in neurological symptoms within the same Frankel grade did occur in these patients. There were no cases of neurological deterioration. Conclusions There was no neurological deterioration due to preoperative embolization, ligation of segmental arteries, or ligation of thoracic nerve roots. Each of the cases with preoperative neurological deficits showed improvement in neurological symptoms. Data in the current study clinically proved that TES is a safe operation with respect to spinal cord blood flow. In TES, the spinal cord is circumferentially decompressed and the spinal column is shortened. An increase in spinal cord blood flow due to spinal shortening in addition to decompression was considered to have brought about a resolution of neurological symptoms with TES.

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