scholarly journals Neurosurgical procedures in pregnancy

2003 ◽  
Vol 18 (1) ◽  
pp. 01-13 ◽  
Author(s):  
Bayram Cirak ◽  
Nejmi Kiymaz ◽  
Memduh Kerman ◽  
Kadir Tahta
Keyword(s):  
Surgical Intervention ◽  
Neurosurgical Procedures ◽  
Low Back ◽  
Intracranial Tumors ◽  
The Past ◽  
Neurologic Disorders ◽  
Neurologically Intact ◽  
Neurosurgical Intervention ◽  
In Pregnancy

PURPOSE: Over the past few decades maternal mortality has progressively declined because of improved management of the major obstetric problems of hemorrhage, infection, and toxemia. As a result, the relative incidence of deaths resulting from non obstetric causes has increased. Chief among nonobstetric causes are neurologic disorders. Those most common during pregnancy are low back pain, intracranial tumors, subarachnoid hemorrhage, and neurotrauma. The management of the neurosurgical pathologies during pregnancy needs some specifications for both the mother and the fetus. METHODS: We performed a retrospective study evaluating the clinical, radiological, and surgical characteristics of 9 patients who have cranial neuropathologies and have undergone neurosurgical intervention. RESULTS: Most of the patients in this study had vaginal delivery. Prominent neurosurgical disease related to cerebral damage. Every patient underwent a laboratory and radiological evaluation. All except one survived the neurosurgical pathology. Neither baby nor mother had significant problem during delivery and neurosurgical intervention. CONCLUSION: Pregnant women may face to every kind of neurosurgical pathology that nonpregnant women have faced. In addition, pregnancy itself, gives rise some metabolic changes in the women and those changes may cause some neurologic pathologies to be symptomatic or to aggravate the present symptomatology. Because of those reasons, close neurologic follow up of a pregnant woman is of vital importance. At the end of a pregnancy having experienced some neurologic interventions including diagnostic evaluation or surgical intervention does not necessitates the cesarean section for a neurologically intact infant and mother.

20 Years of Follow-up Alloimmunization and Hemolytic Disease in Newborn: Has Anything Changed in the Field Over the Years?

2020 ◽  
Vol 232 (06) ◽  
pp. 314-320
Author(s):  
Marjana Jerkovic Raguz ◽  
Zeljka Prce ◽  
Vedran Bjelanovic ◽  
Ivana Bjelanovic ◽  
Sanja Dzida ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Preventive Measures ◽  
Newborn Infants ◽  
Significant Progress ◽  
Hemolytic Disease ◽  
The West ◽  
The Past ◽  
Precautionary Measures ◽  
In Pregnancy

Abstract Objective of the study is to research the epidemiological aspects of maternal alloimmunization against erythrocyte antigens of fetuses (AB0, Rhesus, Lewis, Kell, Duffy and others) and to identify the most common types of hemolytic disease of the newborn (HDN) in the West Herzegovina region. Study Design The 20-year retrospective epidemiological study includes all pregnant women who had been immunologically tested and newborn treated for HDN. Results The indirect antiglobulin (IAT) detected antibodies against antigens in 545 (1.8%) pregnant women of the 29 663 who were tested at the Department of Transfusion Medicine. During the 20-year-long study 310 (1.0%) newborn with HDN were treated. Our results indicate that 42% (230/545) of the pregnant women had AB0 immunization. The most common form of HDN is AB0 HDN 64% (199/310), whereas RhD HDN was treated in 19% (59/310) of the newborn infants. ETR was performed on 29 (19%) infants, 21 (72.4%) with AB0 HDN, and 7 (26%) with RhD HDN. Conclusion This 20-year-long study concludes that, even though there has been significant progress in the prevention of immunization and proactive treatment of HDN, precautionary measures are still required as is the need for gynecologists and obstetricians to be active. The reasons for this are the non-existence of preventive measures for non-RhD immunization, the irregular immunological screening of RhD positive women in pregnancy in the region encompassed by the study in the past few years. The above raises new questions and recommends further research and monitoring of immunization and HDN treatment worldwide.

Fifty Years of Experience with Chordomas in Southeast Scotland

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 166-170 ◽  
Author(s):  
P. O'Neill ◽  
B.A. Bell ◽  
J.D. Miller ◽  
I. Jacobson ◽  
W. Guthrie
Keyword(s):  
Clinical Presentation ◽  
Surgical Intervention ◽  
Slow Growth ◽  
Multicenter Trial ◽  
Treatment Modalities ◽  
Therapeutic Approaches ◽  
Slow Growth Rate ◽  
The Past ◽  
New Therapeutic Approaches

Abstract We report the clinical presentation and management of 34 patients with a histologically proven chordoma, treated in the neurosurgical departments in Edinburgh and Dundee, over the past 50 years. Although these tumors are commonly regarded as being locally invasive with a variable, but generally slow growth rate, they can metastasize, and this may precede surgical intervention, as in one of our patients. Our cases are compared to those in previously published series, and a comprehensive review of the treatment modalities for tumors at various sites is presented. The optimal treatment to be recommended from our own experience, and that of others, is aggressive operation and radiotherapy. A combination of hyperthermia and chemotherapy has shown some promise, but remains untested, and highlights the need for a multicenter trial with long follow-up to allow the evaluation of new therapeutic approaches.

scholarly journals Associations of sickness absence for pain in the low back, neck and shoulders with wider propensity to pain

2020 ◽  
Vol 77 (5) ◽  
pp. 301-308
Author(s):  
David Coggon ◽  
Georgia Ntani ◽  
Karen Walker-Bone ◽  
Vanda E Felli ◽  
Raul Harari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sickness Absence ◽  
Musculoskeletal Pain ◽  
Low Back ◽  
Occupational Groups ◽  
The Past ◽  
Potential Risk Factors ◽  
Psychosocial Influences ◽  
Absence From Work

ObjectivesTo explore the association of sickness absence ascribed to pain at specific anatomical sites with wider propensity to musculoskeletal pain.MethodsAs part of the CUPID (Cultural and Psychosocial Influences on Disability) study, potential risk factors for sickness absence from musculoskeletal pain were determined for 11 922 participants from 45 occupational groups in 18 countries. After approximately 14 months, 9119 (78%) provided follow-up information about sickness in the past month because of musculoskeletal pain, including 8610 who were still in the same job. Associations with absence for pain at specific anatomical sites were assessed by logistic regression and summarised by ORs with 95% CIs.Results861 participants (10%) reported absence from work because of musculoskeletal pain during the month before follow-up. After allowance for potential confounders, risk of absence ascribed entirely to low back pain (n=235) increased with the number of anatomical sites other than low back that had been reported as painful in the year before baseline (ORs 1.6 to 1.7 for ≥4 vs 0 painful sites). Similarly, associations with wider propensity to pain were observed for absence attributed entirely to pain in the neck (ORs up to 2.0) and shoulders (ORs up to 3.4).ConclusionsSickness absence for pain at specific anatomical sites is importantly associated with wider propensity to pain, the determinants of which extend beyond established risk factors such as somatising tendency and low mood. Better understanding of why some individuals are generally more prone to musculoskeletal pain might point to useful opportunities for prevention.

Pediatric Jaw Fractures: Indications for Open Reduction

1979 ◽  
Vol 87 (3) ◽  
pp. 318-322 ◽  
Author(s):  
Anthony S. Krausen ◽  
Martin Samuel
Keyword(s):  
Open Reduction ◽  
Surgical Intervention ◽  
Normal Anatomy ◽  
The Past ◽  
Fractures In Children ◽  
Dental Anatomy ◽  
Jaw Fractures ◽  
The One ◽  
And Function

Jaw fractures in children are generally managed without major surgical intervention. Closed reduction usually is sufficient to restore normal anatomy and function. The one inviolate principle is early treatment. During the past three years, four pediatric jaw fractures that required open reduction were treated. This mode of treatment was necessitated by the limitations imposed by pediatric dental anatomy and by the type of fractures encountered. In at least 24 months of follow-up, no dental problems have been seen.

scholarly journals Adnexal masses during pregnancy: management for a better approach

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Simona Martone ◽  
Libera Troìa ◽  
Stefano Luisi
Keyword(s):  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Obstetric Outcomes ◽  
Negative Effects ◽  
Third Trimester ◽  
Adnexal Masses ◽  
Surgical Expertise ◽  
Gynecological Tumor ◽  
In Pregnancy

AbstractThe incidence of adnexal masses, due to large use of ultrasound during pregnancy, has considerably increased during last years. Large percentage of ovarian masses found during pregnancy consists in simple cysts and they tend to disappear spontaneously during pregnancy. There are still a percentage of masses that persist in second and third trimester that need to be monitored and, sometimes, surgically removed. If the mass increases in size, sometimes, it is itself an indication for delivery via cesarean section. Keeping in mind that adnexal masses diagnosed in pregnancy are generally benign, it is essential to consider that ovarian cancer still represents the second gynecological tumor for incidence after cervical cancer during pregnancy. Most patients are clinically asymptomatic and diagnosis is often a random finding during scheduled ultrasound for pregnancy follow-up. Sometimes, the finding of an ovarian mass requires other imaging technique such as magnetic resonance imaging. Computed tomography is avoided during pregnancy due to negative effects on fetus. Treatment option should be discussed and a multidisciplinary approach is required to set ad individualized plan, considering both mother and fetus. Sometimes the differential diagnosis between benign masses and malignancy is not feasible only through imaging, so that surgical intervention with histological examination is mandatory, even during pregnancy. Plus, although ovarian cyst torsion, hemorrhage, or rupture is uncommon in pregnancy, some women may require emergency surgery for these complications. Until 90s pregnancy was considered an absolute contraindication for laparoscopy, but nowadays both open surgery and laparoscopy can be performed considering mass diameter, gestational age, and surgical expertise. Emerging data are indeed confirming the advantages of laparoscopic surgery compared with laparotomy in term of recovery and need for medical care. The purpose of this review is to assess the incidence of adnexal masses during pregnancy and examine their impact on obstetric outcomes.

scholarly journals Spinal Tuberculosis with Paraplegia in Pregnancy: a Case Report with Management of Spinal TB in Pregnancy

2015 ◽  
Vol 53 (198) ◽  
pp. 123-125
Author(s):  
Sushruti Kaushal ◽  
Santosh Kumar Dora ◽  
Sunil Thakur
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Neurological Status ◽  
Term Infant ◽  
Therapeutic Challenge ◽  
Healthy Term Infant ◽  
Mother And Child ◽  
In Pregnancy

Spinal tuberculosis leading to paraplegia is uncommon in pregnancy and is a diagnostic and therapeutic challenge. We report a case of tubercular paraplegia presenting at 35 weeks of gestation. She was managed with Anti-tubercular drugs and did not require surgical intervention. Her neurological status improved and she was allowed to go in labour. She delivered a healthy term infant by cesarean. At three months follow-up, both mother and child are doing well.  Keywords: paraplegia; pregnancy; spinal tuberculosis.

scholarly journals Apparently benign craniocervical signs in achondroplasia: “neurologic leftovers” identified through a retrospective dataset

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Cory J. Smid ◽  
Janet M. Legare ◽  
Peggy Modaff ◽  
Richard M. Pauli
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Craniocervical Junction ◽  
Neurologic Complications ◽  
Clinically Significant ◽  
High Cervical ◽  
Neurologically Intact ◽  
Apparent Evidence ◽  
Neurosurgical Intervention

Abstract Background Achondroplasia is the most common dwarfing disorder. It can result in a variety of sequelae, including neurologic complications, among which high cervical myelopathy is one of particular concern. However, some individuals with achondroplasia appear to have persistent signs by physical examination that, while they might suggest the presence of high cervical myelopathy, remain isolated, non-progressive and apparently benign. To document and quantify these apparently benign craniocervical signs (ABCS) a cohort of 477 individuals with achondroplasia was retrospectively analyzed and information regarding persistent neurologic features suggestive of high cervical myelopathy was recorded in a REDCap database. Results Within this cohort, 151 individuals (31.7%) had neurologic examinations that were in some manner concerning. Of these, 46 (30.5% of the subpopulation) required cervicomedullary decompressive surgery. The remaining 105 had concerning signs by examination but no apparent evidence for clinically significant cervical myelopathy. Of those 105 individuals, 88 (83.8%; 18.4% of the entire population) remained neurologically intact throughout their follow-up, and without clinical sequelae. Conclusions It appears that many individuals with achondroplasia, if carefully examined, may demonstrate isolated, initially concerning signs suggestive of cervical myelopathy, but in the vast majority these are benign and do not indicate need for aggressive neurosurgical intervention. Further investigations may help to identify ways to differentiate these benign features from the less common but more problematic true myelopathic ones. We postulate that the “neurologic leftovers” may arise from temporally remote, subtle damage to the spinal cord at the craniocervical junction, which damage otherwise does not reach clinical relevance.

Intact arch spondylolisthesis

1985 ◽  
Vol 63 (6) ◽  
pp. 840-844 ◽  
Author(s):  
Eben Alexander ◽  
David L. Kelly ◽  
Courtland H. Davis ◽  
Joe M. McWhorter ◽  
William Brown
Keyword(s):  
Intervertebral Disc ◽  
Cauda Equina ◽  
Leg Pain ◽  
Low Back ◽  
Content Type ◽  
The Past ◽  
Cauda Equina Compression ◽  
Male Patients ◽  
Almost All

✓ Over the past 11 years, the authors have treated 50 cases of intact arch spondylolisthesis. There were 38 female and 12 male patients, and all but 11 were older than 60 years of age. Almost all had severe low-back pain made worse by standing or walking. Other common manifestations were unilateral leg pain, numbness or weakness of the leg, and evidence of mild cauda equina compression. Severe cauda equina compression was rare. Myelography invariably showed an extradural dorsal compression. A waist deformity was characteristic in many patients, but 12 had a complete block. In 15 patients (30%) the myelographic impression was that of a herniated intervertebral disc. Most subluxations were of L-4 on L-5. At operation, the facets were found to be thickened, distorted, and irregular. All patients were treated with a wide decompression and laminectomy, which included a medial facetectomy of the inferior and superior facets. An intervertebral disc was removed in 10 patients. Follow-up monitoring of 41 patients (for an average period of 36 months) showed that 26 (63%) were pain-free, 11 had less pain, and four were unimproved. Five other patients with short follow-up periods (average 5 months) were all improved.

A History of Low Back Injury is a Risk Factor for Recurrent Back Injuries in Varsity Athletes

2001 ◽  
Vol 29 (6) ◽  
pp. 795-800 ◽  
Author(s):  
Hunter S. Greene ◽  
Jacek Cholewicki ◽  
Marc T. Galloway ◽  
Carolyn V. Nguyen ◽  
Andrea Radebold
Keyword(s):  
Incidence Rates ◽  
Back Injury ◽  
Low Back ◽  
Factors Associated ◽  
The Past ◽  
Low Back Injury ◽  
Recurrent Injury ◽  
Varsity Athletes ◽  
History Of

In this prospective study, we investigated whether a history of previous low back injury and dissatisfaction with a coach and teammates could predict future low back injury in varsity athletes during a 1-year follow-up period. Of 679 Yale varsity athletes surveyed in 1999, 18.3% (124) reported that they had sustained a low back injury within the past 5 years, and 6.8% (46) sustained a low back injury in the follow-up season. There were no differences in incidence rates between men and women or between athletes involved in contact or noncontact sports. A history of low back injury was the significant predictor for sustaining low back injury in the following year, and athletes who reported previous low back injury were at three times greater risk. Athletes who still had pain at the time of the survey were six times more likely to sustain a low back injury than were athletes without a history of low back injury. These results suggest that some risk factors associated with a history of low back injury predispose athletes to sustain recurrent injury. They may be congenital or a result of insufficient recovery time after the first low back injury episode.

scholarly journals Treatment of relapsed, residual and neglected clubfoot: adjunctive surgery

2019 ◽  
Vol 13 (3) ◽  
pp. 293-303 ◽  
Author(s):  
M. Eidelman ◽  
P. Kotlarsky ◽  
J. E. Herzenberg
Keyword(s):  
Operative Treatment ◽  
Surgical Intervention ◽  
Surgical Approaches ◽  
Older Children ◽  
Level Of Evidence ◽  
The Past ◽  
Percutaneous Tenotomy ◽  
Surgical Options ◽  
Perfect Adherence

Over the past two decades, the Ponseti ‘conservative’ (non-surgical) method of clubfoot treatment has been almost universally adopted worldwide. As a result, the need for operative treatment for clubfoot has decreased dramatically. However, even Ponseti himself routinely used surgery for certain patients: at least 90% of feet need percutaneous tenotomy, and 15% to 40% may require tibialis anterior tendon transfer. Additionally, relapses are common, sometimes necessitating further surgical intervention. Relapses are recurrent deformities in previously well corrected feet. Residual deformities may be defined as persistent deformities in incompletely corrected feet. In addition, in many parts of the developing world, neglected clubfoot is still a major challenge. Many neglected feet can be treated with Ponseti principles, particularly in younger children. However, in older children and adults, surgical approaches are more likely to be needed. Major reasons for relapsed/residual clubfoot include incomplete application of the Ponseti principles, inability to adhere to the foot abduction brace protocol, failure to recommend a complete course of bracing and inadequate follow-up. Sometimes, despite excellent treatment, and perfect adherence to the bracing protocols, there are still relapses, related to intrinsic muscle imbalance. We describe several solutions that include reinstitution of Ponseti casting and ‘á la carte’ operative treatment. As an alternative for particularly stubborn cases, application of a hexapod external fixator can be a powerful tool. In order to be a full-service clubfoot specialist, and not only a Ponseti practitioner, one must have in their toolbox the full gamut of adjunctive surgical options. Level of Evidence: V

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