Spinal meningiomas: Clinical and therapeutic tonsiderations

Open Medicine ◽  
2008 ◽  
Vol 3 (3) ◽  
pp. 322-326
Author(s):  
Johannes Schröder ◽  
Bernhard Fischer ◽  
Stefan Palkovic ◽  
Hansdetlef Wassmann
Keyword(s):  
Spinal Canal ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Complete Removal ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Before And After ◽  
Patient Will ◽  
Spinal Meningiomas ◽  
The Mean

AbstractMeningiomas of the spinal canal are rare, in contrast to their cranial counterparts. This study reports on the dominant features of spinal meningiomas before and after treatment. We treated 30 patients (23 female) with meningiomas of the spinal canal from 1992 to 2003. The mean age was 68 (range: 43–91). Upon admission, 26 patients presented with a marked neurological deficit (11 paraparesis, 9 motor weakness, 4 myelopathic ataxia, 1 quadriplegia, and 1 cauda equina syndrome). Two patients had sensory deficits, and two had pain only. The distribution of the tumors was as follows: 8 cases were cranio-cervical, 1 case was cervical, 6 cases were at the cervico-thoracic junction, 9 cases were of the thoracic spine, 5 cases were of the thoracolumbar spine, and 1 case was of the lumbar spine. Five cases also had intracranial manifestations. The mean interval between the onset of the first symptoms and treatment was 12 months. All cases were treated via (hemi)-laminectomy for complete removal of the tumor and occasionally via duraplasty. After a mean follow-up of 3 years, symptoms had improved by 3 points (on a 5-point scale) in 3 cases, by 2 points in 7 cases, and by 1 point in 12 cases; 7 cases were unchanged, and 1 case had worsened by 1 point. We observed 3 local recurrences. One case developed manifestations at a different site. Spinal meningiomas are often diagnosed late, after they have already caused major neurological deficits. Nevertheless, owing to their benign character, the outcome is favorable when treated appropriately. The outcome depends above all on the initial neurological status. The worse the deficit is, the less probable it is that the patient will recover neurologically.

Craniotomy for Fenestration of Multiloculated Hydrocephalus in Pediatric Patients

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. 100-106 ◽  
Author(s):  
David I. Sandberg ◽  
J. Gordon McComb ◽  
Mark D. Krieger
Keyword(s):  
Pediatric Patients ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Ventricular Catheter ◽  
Shunt System ◽  
Neurological Outcomes ◽  
Multiloculated Hydrocephalus ◽  
Before And After ◽  
Posterior Parietal ◽  
Ventricular Catheters

Abstract OBJECTIVE: To assess the treatment of progressive multiloculated hydrocephalus by craniotomy for microsurgical fenestration of cerebrospinal fluid (CSF) compartments to minimize the number of ventricular catheters. METHODS: We studied 33 pediatric patients who underwent craniotomies for fenestration of progressive multiloculated hydrocephalus between 1989 and 2003. In 20 of 33 patients, hydrocephalus was attributed to intraventricular hemorrhage associated with prematurity. Twenty-three of 33 patients had previous central nervous system infections. Craniotomy was typically performed via a posterior parietal approach. Communication between bilateral supratentorial loculated compartments and posterior fossa compartments was achieved. Surgical and neurological outcomes were assessed. RESULTS: Fenestration of loculated CSF spaces was performed successfully in all patients. No new neurological deficits were noted after surgery, and no patients required intraoperative blood transfusions. CSF infections within 3 months after surgery occurred in 4 of 33 patients. Over a median follow-up period of 3.7 years (range, 1.5 mo to 8.7 yr), 19 of 33 patients required additional fenestration procedures. The number of repeat fenestration procedures ranged from one to six, and a total of 47 additional fenestrations were performed in these 19 patients. The majority of patients (n = 25) ultimately required shunt systems with only one ventricular catheter. The neurological status of these patients was extremely poor both before and after surgery. Twenty-nine of 33 patients were severely delayed, and four were mildly delayed. CONCLUSION: Fenestration of multiloculated CSF compartments can enable most patients to function with a single ventricular catheter shunt system. Neurological status remains poor in this patient population.

Postoperative ischemic changes following brain metastasis resection as measured by diffusion-weighted magnetic resonance imaging

2013 ◽  
Vol 119 (6) ◽  
pp. 1395-1400 ◽  
Author(s):  
Jens Gempt ◽  
Julia Gerhardt ◽  
Vivien Toth ◽  
Stefanie Hüttinger ◽  
Yu-Mi Ryang ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Neurological Deficit ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Brain Irradiation ◽  
Diffusion Weighted ◽  
The Mean

Object Brain metastases occur in 10% to 40% of patients harboring cancer. In cases of neurosurgical metastasis resection, all postoperative neurological deterioration should be avoided. Reasons for postoperative deficits can be direct tissue damage due to resection, hemorrhage, venous congestive infarcts, or arterial ischemic events leading to tissue infarction. The aim of this study was to evaluate whether postoperative ischemic infarctions occur in surgery for brain metastasis and to determine their influence on new postoperative neurological deficits. Methods Patients who underwent resection of brain metastases and had preoperative and early postoperative (within 48 hours) MRI scans, including diffusion-weighted imaging sequences and apparent diffusion coefficient maps, between January 2009 and May 2012 were included in this study. Clinical and histopathological data (histopathological results, pre- and postoperative neurological status, and previous tumor-specific therapy) were recorded. Results One hundred twenty-two patients (56 male, 66 female) who underwent resection of brain metastases were included. The patients' mean age was 60 years (range 21–89 years). The mean time span from initial tumor diagnosis to resection of brain metastasis was 44 months (range 0–338 months). The mean preoperative Karnofsky Performance Status was 80% (exact mean 76% ± 17% [SD]), and the mean postoperative value was 80% (exact mean 78% ± 17%). Twelve (9.8%) of the 122 patients had postoperative permanent worsening of a neurological deficit or a new permanent neurological deficit; 44 (36.1%) of the 122 patients had postoperative ischemic lesions. When comparing patients with and without previous brain irradiation, 53.8% of patients with previous brain irradiation had ischemic lesions on postoperative imaging compared with 31.3% of patients without previous brain irradiation (p = 0.033). There was a significant association between ischemia and postoperative neurological status deterioration (transient or permanent); 13 (29.5%) of 44 patients with ischemic lesions had deterioration of their neurological status compared with 7 (9%) of the 78 patients who did not have ischemic lesions (p = 0.003). Conclusions This study demonstrates a high prevalence of vascular incidents in patients undergoing resection for metastatic brain disease. Patients harboring postoperative ischemic lesions detected by MRI have a higher rate of neurological deficits (transient or permanent). Patients who had previous irradiation therapy are at higher risk of developing postoperative ischemic lesions. A large number of postoperative neurological deficits are caused by ischemic incidents.

scholarly journals Lesión dural asociada a fracturas de charnela toracolumbar y lumbares con compromiso del muro posterior. Relación con las variables del sistema de clasificación AOSpine. [Thecal sac injury secondary to burst fractures of the thoracolumbar and lumbar spine, and its association with the AOSpine Classification System variables].

2019 ◽  
Vol 84 (3) ◽  
pp. 216-223
Author(s):  
Guillermo Alejandro Ricciardi ◽  
Ignacio Gabriel Garfinkel ◽  
Gabriel Genaro Carrioli ◽  
Daniel Oscar Ricciardi
Keyword(s):  
Vertebral Body ◽  
Neurological Deficit ◽  
Classification System ◽  
Spinal Canal ◽  
Body Wall ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Acute Angle ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures

Introducción: Las lesiones del saco dural con atrapamiento de la cauda equina entre los fragmentos óseos pueden estar asociadas con fracturas toracolumbares.Objetivo: Realizar un análisis retrospectivo de las variables clínico-radiográficas y el sistema de clasificación AOSpine y la posibilidad de lesión dural asociada en una serie de fracturas toracolumbares por estallido, tratadas en nuestro Centro.Materiales y Métodos: Estudio retrospectivo, observacional de una serie de pacientes con fracturas toracolumbares con compromiso del muro posterior operados en nuestra institución, entre enero de 2012 y diciembre de 2017.Resultados: Se incluyeron 46 pacientes, 16 casos con lesión del saco dural asociada. Las variables porcentaje de ocupación del canal, distancia interpedicular, ángulo del fragmento retropulsado y déficit neurológico asociado mostraron diferencias estadísticamentesignificativas según la comparación en función de la presencia o ausencia de lesión dural (p = 0,046, p = 0,007, p = 0,046 y p = 0,004, respectivamente).Conclusiones: Según nuestros resultados, la lesión dural traumática podría ser contemplada en la planificación del tratamiento de fracturas toracolumbares ante fragmentos voluminosos del muro posterior con ángulo agudo, compromiso severo del canal raquídeo, distancia interpedicular elevada y daño neurológico asociado, tal como se propone en la bibliografía. AbstractIntroduction: Fractures of the thoracolumbar spine can trigger thecal sac injuries due to the impingement of the cauda equina between bone fragments.Objective: To carry out a retrospective analysis of clinical and radiological variables, the AOSpine Classification System and the possibility of secondary thecal sac injury in a series of thoracolumbar burst fractures treated at our center.Materials and Methods: A retrospective, observational study of a series of patients with thoracolumbar fractures with compromise of the posterior vertebral body wall, who underwent surgery at our center between January 2012 and December 2017.Results: Forty-six patients were included, 16 of which had secondary thecal sac injury. The differences in the variables—percentage of spinal canal involvement, interpedicular distance, angle of the retropulsed fragment, neurological deficit and type C fractures—were statistically significant according to the comparison made with the presence or absence of thecal sac injury (p=0.046, p=0.007, p=0.046, p=0.004, p=0,001 respectively).Conclusions: This study suggests that traumatic thecal sac injury could be suspectedwhen managing burst fractures with prominent fragments in the posterior vertebral body wall, acute angle of the retropulsed fragment, severe compression of the spinal canal, wide interpedicular distance, neurological deficit and fracture displacement (fracturetype C according to the AOSpine Classification System).

Anterior expandable strut cage replacement for osteoporotic thoracolumbar vertebral collapse

2006 ◽  
Vol 4 (6) ◽  
pp. 454-462 ◽  
Author(s):  
Kenzo Uchida ◽  
Shigeru Kobayashi ◽  
Hideaki Nakajima ◽  
Yasuo Kokubo ◽  
Takafumi Yayama ◽  
...  
Keyword(s):  
Neurological Status ◽  
Neurological Deficits ◽  
Vertebral Body Replacement ◽  
Vertebral Collapse ◽  
Expandable Cage ◽  
Cage Subsidence ◽  
The Mean ◽  
Type 3

Object The authors investigated the usefulness of using an expandable cage strut in anterior reconstruction after osteoporotic vertebral collapse in patients with neurological deficits. Methods Twenty-eight patients who had undergone expandable cage strut–augmented anterior thoracolumbar reconstruction participated in a follow-up review for a mean of 4.9 years. Radiographs were reviewed for kyphosis, lateral tilt of the implant, cage subsidence, the presence of a solid fusion mass, and instrumentation failure. Changes in neurological status and visual analog scale (VAS) pain score, as well as technique-related complications, were examined. The mean angles ± the standard deviations of kyphosis correction 4 to 6 weeks after surgery and at final follow-up examination were 10.4 ± 7.6° and 5.6 ± 6.0°, respectively. The mean subsidence of the expandable cage within the adjacent vertebrae was 2.5 ± 3.0 mm at the final follow-up examination. Neurological improvement at the final follow up was more significant in patients with Type 1 (wedge-type) than Type 2 (flat-type) (p = 0.037) or Type 3 (concave-type) (p = 0.006) vertebral collapse. Follow-up VAS scores were significantly higher in patients with Type 1 than Type 3 collapse (p = 0.012). In all cases the authors observed solid union with incorporation of the cage. There were no surgery-related complications. Conclusions An expandable titanium cage strut seems useful in vertebral body replacement in patients with osteoporotic thoracolumbar collapse. Favorable results were obtained in cases of Type 1 collapse (wedge type) in which the middle and posterior columns remained comparatively intact.

scholarly journals Management of spinal dural arterio venous fistula with peri-medullar drainage

2019 ◽  
pp. 486-491
Author(s):  
Assoumane Ibrahim ◽  
Loucif Houari ◽  
Sanoussi Samuila ◽  
Sidi Said Abderahmane ◽  
Abdelhalim Morsli
Keyword(s):  
Venous Malformation ◽  
Clinical Status ◽  
Venous Drainage ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Functional Rehabilitation ◽  
Disability Score ◽  
Surgical Department ◽  
Before And After ◽  
Venous Fistula

Introduction: Spinal Dural Arterio Venous Fistula (SDAVF) is an arteriovenous communication on the spinal dura with peri-medullar venous drainage. It is a curable cause of myelopathy and the most common form of spinal arterio venous malformation (AVM). The average age of revelation is the fifth decade; it is a diagnostic and therapeutic emergency. Materials and methods: This is a retrospective study conducted in the neuro surgical department of CHU Bab El Oued in Algiers during a five years time from November 2013 to September 2018. We assessed the clinical status of patients according to the Aminoff-Logue disability score before and after surgery. All patients did a total spine MRI followed by a Medullar angiography which facilitated the pin-pointing of the exact location of the dural fistula. The mean follow-up is 30 months. Results: There were five males and two females, all of them older than 45 years of age. At the admission, patients presented with signs of neurological deficits. After the diagnosis of SDAVF the surgical intervention consisted of a disconnection of the arteriovenous communication by coagulation and section of the fistula at the foot of the vein after a laminectomy. Functional rehabilitation was prescribed for all patients and they were regularly followed-up. Conclusion: Treatment of AVF is surgical or endovascular. Results depend largely on preoperative neurological status.

Surgical correction of lumbar kyphotic deformity: posterior reduction “eggshell” osteotomy

2000 ◽  
Vol 92 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Olumide A. Danisa ◽  
Dennis Turner ◽  
William J. Richardson
Keyword(s):  
Back Pain ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Surgical Correction ◽  
Kyphotic Deformity ◽  
Lumbar Region ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. Progressive kyphotic deformity of the lumbar or thoracolumbar spine may lead to back pain, cosmetic deformity, and risk of neurological compromise. The authors describe a series of patients in whom they performed a singlestage, posterior reduction (“eggshell”) osteotomy procedure to improve sagittal contour by creating lordosis within a single vertebral body. Methods. From 1995 to 1997 the authors performed 12 osteotomy procedures in 11 patients with thoracolumbar or lumbar kyphosis. Seven patients presented with iatrogenic deformity, three with deformity secondary to traumatic injury, and one patient with ankylosing spondylitis. Their mean age at time of surgery was 46.6 years (range 23–78 years). All patients suffered from back pain and were unable to stand upright, but in only one patient were neurological findings demonstrated. The mean preoperative deformity was −26° (range −90 to 0°). At 6-month follow-up examination the mean sagittal contour measured 17.5° (range −17 to 44°), indicating that the mean surgical correction was 40.1° (range 25 to 58°). All patients reported decreased back pain at follow up, and none required narcotic analgesic medication. Complications included a dense paresis that developed immediately postoperatively in a patient who was found to have residual dural compression, which was corrected by emergency decompressive surgery. One elderly patient suffered a perioperative cerebrovascular accident, and three patients suffered neurapraxia with transient muscle weakness of the quadriceps. There was one case of a dural tear. There were no deaths, and prolonged intensive care stays were not required. Conclusions. Single-level posterior reduction osteotomy provides excellent sagittal correction of kyphotic deformity in the lumbar region, with a risk of cauda equina and root and plexus compromise due to the extensive neural exposure.

SPINAL MENINGIOMA SURGERY IN ELDERLY PATIENTS WITH PARAPLEGIA OR SEVERE PARAPARESIS

Neurosurgery ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. 503-510 ◽  
Author(s):  
Oumar Sacko ◽  
Claire Haegelen ◽  
Vivien Mendes ◽  
Adam Brenner ◽  
Musa Sesay ◽  
...  
Keyword(s):  
Complete Recovery ◽  
Neurological Status ◽  
Influential Factors ◽  
Neurological Deficits ◽  
Mortality And Morbidity ◽  
Spinal Meningiomas ◽  
American Society ◽  
One Year ◽  
Meningioma Surgery ◽  
American Society Of Anesthesiologists

Abstract OBJECTIVE In a multicenter study, 102 patients aged 70 years or older with paraplegia or severe paraparesis, and who underwent operation for spinal meningiomas, are presented to correlate surgery and outcome and to determine the most influential factors that affected this outcome. METHODS Five French neurosurgical centers participated in this retrospective study between 1990 and 2007. Pre- and postoperative neurological status were assessed using a grading system. All patients underwent operation, and neurological evaluations were conducted 3 months and 1 year after surgery. The median follow-up period was 49.5 months (range, 12–169 months). Data were analyzed using a multiple logistic regression model. RESULTS Twenty-six patients were paraplegic (Grade 4). Complete tumor removal was obtained in 93 patients. There was no surgical mortality, and morbidity was 9%. Three months after surgery, 7 of the patients were unchanged, 87 patients had improved, and 8 were not evaluated. One year after surgery, 7 of the 100 surviving patients were clinically unchanged and 93 had improved. Of those who had improved, 49 patients experienced complete recovery. CONCLUSION Advanced age did not seem to contraindicate surgery, even in patients with severe preoperative neurological deficits and/or an American Society of Anesthesiologists class of III. Quality of life can be improved in most cases.

Nimodipine and Chronic Vasospasm in Monkeys: Part 1 Clinical and Radiological Findings

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 129-136 ◽  
Author(s):  
Michael Nosko ◽  
Bryce Weir ◽  
Christel Krueger ◽  
David Cook ◽  
Susan Norris ◽  
...  
Keyword(s):  
Cerebral Vasospasm ◽  
Neurological Status ◽  
Neurological Deficits ◽  
High Dose ◽  
Primate Model ◽  
Cerebral Vessel ◽  
Significant Difference ◽  
Before And After ◽  
The Right ◽  
Chronic Cerebral Vasospasm

Abstract The efficacy of the calcium channel blocker nimodipine in the prevention of chronic cerebral vasospasm (VSP) and delayed ischemia after subarachnoid hemorrhage (SAH) in monkeys was examined in a blind, randomized, placebocontrolled trial. The primate model developed in this laboratory reliably induces chronic cerebral vasospasm and can induce pathologically proven delayed ischemic neurological deficits (DINDs). With standard microsurgical procedures, an average 6.4-ml autologous hematoma was placed directly against the major anterior cerebral vessels in the right basal subarachnoid spaces of 24 monkeys. The monkeys were randomized to one of four groups and were treated orally q8h for 7 days with nimodipine (3, 6, or 12mg/kg) or placebo. An additional 2 monkeys underwent the surgical procedure without clot placement. Drug administration began between 14 and 20 hours after clot placement. Indices monitored before and after SAH included neurological status, angiographic cerebral vessel caliber, and cerebral blood flow. Significant VSP (25 to 100% reduction in vessel caliber) was present on Day 7 on the clot side in 83% of the animals (P ≤ 0.001). There was no significant difference (P > 0.05) in the incidence of VSP among the four groups. Similarly, there was no significant difference (P > 0.05) in the mean vessel caliber reduction after SAH among the four treatment groups. There was no VSP present on Day 7 in the sham-operated animals. One animal receiving high dose nimodipine (12 mg/kg p.o. q8h) developed a DIND on Day 5 after SAH. A second animal in the 12-mg/kg group developed a transient neurological deficit between Days 4 and 7.

Surgical technique and results of endoscopic anterior spinal canal decompression

2005 ◽  
Vol 2 (2) ◽  
pp. 128-136 ◽  
Author(s):  
Rudolf Beisse ◽  
Thomas Mückley ◽  
Meic H. Schmidt ◽  
Matthias Hauschild ◽  
Volker Büren
Keyword(s):  
Spinal Canal ◽  
Thoracolumbar Spine ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Disc Disease ◽  
Content Type ◽  
Neurological Improvement ◽  
Intercostal Neuralgia ◽  
Anterior Access ◽  
Fine Print

Object. Decompression of the spinal canal in the management of thoracolumbar trauma is controversial, but many authors have advocated decompression in patients with severe canal compromise and neurological deficits. Anterior decompression, corpectomy, and fusion have been shown to be more reliable for spinal canal reconstruction than posterior procedures; however, traditional anterior-access procedures, thoracotomy, and thoracoabdominal approaches are associated with significant complications. Endoscopy-guided spinal access avoids causing these morbidities, but it has not been shown to yield equivalent results in spinal canal clearance. This study was conducted to demonstrate the effectiveness of endoscopic spinal canal decompression and reconstruction quantitatively by using pre- and postoperative computerized tomography (CT) scanning. Methods. Thirty patients with thoracolumbar canal compromise underwent endoscopic anterior spinal canal decompression, interbody reconstruction, and stabilization for fractures (27 cases), and tumor, infection, and severe degenerative disc disease (one case each). The mean follow-up period was 42 months (range 24 months–6 years). Neurological examinations, Frankel grades, radiological studies, and intraoperative findings were prospectively collected. Spinal canal clearance quantified on pre- and postoperative CT scans improved from 55 to 110%. A total of 25% of patients with complete paraplegia and 65% of those with incomplete neurological deficit improved neurologically. The complication rate was 16.7% and included one reintubation, two pleural effusions, one intercostal neuralgia, and one persistent lesion of the sympathetic chain. Conclusions. The authors describe the endoscopic technique of anterior spinal canal decompression in the thoracolumbar spine. The morbidities associated with an open procedure were avoided, and excellent spinal canal clearance was accomplished as was associated neurological improvement.

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