Retained foreign needle in the thoracic spinal canal in a child: Case report

Background: The presence of retained foreign bodies in the spinal canal has been reported in the literature. They are attributed to retained pieces of medical equipment after surgery, or, following trauma, to residual bullets, glass fragments, or knife blades. Although some retained materials do not cause any neurological deficits in the short run, others may become symptomatic months later. Case Description: A 2-year-old male presented with a history of intermittent fever and mild lower extremity weakness. Notably, the original infectious workup was negative. However, a noncontrast CT scan later documented a needle-shaped foreign body in the spinal canal at the T10 level. During the T10 laminectomy, a needle (i.e. from a medical syringe) was removed, the patient remained neurologically intact. The foreign body turned out to be a medical syringe needle tip. Conclusion: A 2-year-old male presented with fevers and mild lower extremity weakness attributed to an intraspinal needle tip found utilizing CT at the T10 level. T10 laminectomy allowed for removal of a small needle tip. This shows the importance of removing retained spinal foreign bodies to avoid further/future neurological injury, and/or the potential risks/complications of foreign body migration/sequestration.

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Outcome of surgical untethering of tethered cord syndrome in adults due to spina bifida occulta

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v15i1.82 ◽

2019 ◽

Vol 15 (1) ◽

pp. 68-74

Author(s):

Bassam Mahmood Flamerz Arkawazi

Keyword(s):

Spina Bifida ◽

Lower Extremity ◽

Tethered Cord ◽

Adult Patients ◽

Spina Bifida Occulta ◽

Neurological Deficits ◽

Neurological Injury ◽

Early Surgery ◽

Lower Extremity Weakness ◽

Pain Status

Background:. Children with spina bifida occulta require early surgery to prevent neurological deficits. The treatment of patients with a congenitally tethered cord who present in adulthood remains controversial. Objective: The aim of this study is to describe the outcome obtained in 61 adult patients with congenital TCS and no prior surgical treatment who underwent surgical untethering. Methods: This prospective study was conducted on 61 adult patients who underwent surgical untethering for spina bifida occulta at four neurosurgical centers in Baghdad / Iraq between March 2000 and January 2018. Patients who had undergone prior myelomeningocele repair or tethered cord release surgery were excluded. The most common intraoperative findings were lipomyelomeningocele (41%) and a tight terminal filum (36%). The follow-up duration ranged from 10.8 to 149.5 months (mean 20.9 months). Of the 34 patients with back pain, status improved in 65%, worsened in 3%, remained unchanged in 18%, and improved and later recurred in 15%. Lower-extremity pain improved in 16 patients (53%), remained unchanged in 23%, improved and then recurred in 17%, and worsened in 7%. Lower-extremity weakness improved in 47%, remained unchanged in 47%, and improved and then recurred in 5%. Finally, of the 17 patients with lower-extremity sensory changes, status improved in 35%, remained unchanged in 35%, and the information on five patients was unavailable. Surgical complications included three wound infections, one cerebrospinal fluid leak, and two pseudomeningoceles requiring surgical revision. One patient developed acute respiratory distress syndrome and sepsis postoperatively and died several days later. Conclusions: Adult-age presentation of a congenital tethered cord is unusual. Despite a slight increase in postoperative neurological injury in adults, surgery has relatively low risk and offers good potential for neurological improvement or stabilization. As in children, we recommend early surgery in adults with this disorder. The decision to undertake surgery, however, should be modulated by other factors such as a patient’s general medical condition and risk posed by anesthesia.

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Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.3.210 ◽

2007 ◽

Vol 6 (3) ◽

pp. 210-215 ◽

Cited By ~ 32

Author(s):

Sharad Rajpal ◽

R. Shane Tubbs ◽

Timothy George ◽

W. Jerry Oakes ◽

Herbert E. Fuchs ◽

...

Keyword(s):

Spina Bifida ◽

Lower Extremity ◽

Medical Condition ◽

Tethered Cord ◽

Spina Bifida Occulta ◽

Neurological Deficits ◽

Neurological Injury ◽

Early Surgery ◽

Lower Extremity Weakness ◽

Pain Status

Object Children with spina bifida occulta require early surgery to prevent neurological deficits. The treatment of patients with a congenitally tethered cord who present in adulthood remains controversial. Methods The authors studied the medical records of 61 adult patients who underwent surgical untethering for spina bifida occulta at three institutions between 1994 and 2003. Patients who had undergone prior myelomeningocele repair or tethered cord release surgery were excluded. The most common intraoperative findings were lipomyelomeningocele (41%) and a tight terminal filum (36%). The follow-up duration ranged from 10.8 to 149.5 months. Of the 34 patients with back pain, status improved in 65%, worsened in 3%, remained unchanged in 18%, and improved and later recurred in 15%. Lower-extremity pain improved in 16 patients (53%), remained unchanged in 23%, improved and then recurred in 17%, and worsened in 7%. Lower-extremity weakness improved in 47%, remained unchanged in 47%, and improved and then recurred in 5%. Finally, of the 17 patients with lower-extremity sensory changes, status improved in 35%, remained unchanged in 35%, and the information on five patients was unavailable. Surgical complications included three wound infections, one cerebrospinal fluid leak, and two pseudomeningoceles requiring surgical revision. One patient developed acute respiratory distress syndrome and sepsis postoperatively and died several days later. Conclusions Adult-age presentation of a congenital tethered cord is unusual. Despite a slight increase in postoperative neurological injury in adults, surgery has relatively low risk and offers good potential for neurological improvement or stabilization. As they do in children, the authors recommend early surgery in adults with this disorder. The decision to undertake surgery, however, should be modulated by other factors such as a patient's general medical condition and risk posed by anesthesia.

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Endovascular Treatment of an Aneurysm of a Persistent Primitive Hypoglossal Artery With Complete Resolution of Brainstem Compressive Symptoms: Case Report

Neurosurgery ◽

10.1227/neu.0b013e3182077d75 ◽

2011 ◽

Vol 68 (3) ◽

pp. E854-E857 ◽

Cited By ~ 9

Author(s):

Ferdinand K. Hui ◽

Albert J. Schuette ◽

Charles M. Cawley

Keyword(s):

Lower Extremity ◽

Complete Resolution ◽

Mass Effect ◽

Neurological Deficits ◽

Lower Extremity Weakness ◽

Computed Tomographic ◽

Hypoglossal Artery ◽

Patient Reported ◽

Persistent Primitive Hypoglossal Artery ◽

The Right

Abstract BACKGROUND AND IMPORTANCE: Aneurysms of the posterior circulation may manifest with neurological deficits related to mass effect on the brainstem. We present an unusual case of an aneurysm resulting in selective lower-extremity weakness and gait instability. CLINICAL PRESENTATION: A 61-year-old man presents with progressively worsening gait instability over the course of several months. A magnetic resonance image and computed tomographic angiogram demonstrate a persistent hypoglossal artery associated with an aneurysm invaginating into the pontomedullary junction. The patient manifested only lower-extremity symptoms. An endovascular approach through the right internal carotid artery and persistent primitive hypoglossal artery was assayed, coiling off the aneurysm with complete angiographic occlusion. One month after the procedure, the patient reported marked improvement in symptoms with residual difficulty walking. At the 1-year postprocedure interval, he reported nearly complete resolution of symptoms. CONCLUSION: Endovascular therapy of an aneurysm invaginating into the brainstem is safe and efficacious.

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Penetrating Craniocerebral Injury by the Hook of a School Desk

Pediatric Neurosurgery ◽

10.1159/000512863 ◽

2021 ◽

Vol 56 (2) ◽

pp. 152-156

Author(s):

Yahya Guvenc ◽

Mustafa Sakar ◽

Seymur Niftaliyev ◽

Abdulmammad Guliyev ◽

Ismail Simsek ◽

...

Keyword(s):

Foreign Body ◽

High Frequency ◽

Causes Of Death ◽

Foreign Bodies ◽

Pediatric Patients ◽

Epileptic Seizures ◽

Neurological Deficits ◽

Surgical Removal ◽

Case Presentation ◽

Cranial Injury

Introduction: Although penetrating cranial injuries are rare in pediatric patients, these injuries can lead to morbidity and mortality. Removal of a gigantic foreign body from the cranium requires proper management as it has high risk of further brain damage and seizures. Case Presentation: We report the case of a patient with cranial injury caused by hitting the head to the hook of a school desk. Due to the extreme nature of the injury, the following additional steps were necessary: taking help from a local firefighter team to cut the desk, surgical removal of the foreign body, and cranioplasty after 6 months. Following this, he was discharged without neurological deficits. Discussion/Conclusion: Neurotrauma is one of the major causes of death in children. The damage and effect of the injuring foreign body depends on its size, shape, velocity, trajectory, and entry point. It should be kept in mind that any high-frequency processes applied on the extracranial parts of conductive objects, such as metal bars, may trigger seizures. Preoperative extracranial intervention for huge penetrating foreign bodies should be performed under anticonvulsant administration and intubation to decrease the risk of epileptic seizures and its complications.

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Two-level thoracic pedicle subtraction osteotomy for progressive post-laminectomy kyphotic deformity following resection of an unusual thoracolumbar intradural extramedullary tumor

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.7.peds11526 ◽

2012 ◽

Vol 10 (4) ◽

pp. 334-339 ◽

Cited By ~ 9

Author(s):

Brian J. Kelley ◽

Michele H. Johnson ◽

Alexander O. Vortmeyer ◽

Brian G. Smith ◽

Khalid M. Abbed

Keyword(s):

Lower Extremity ◽

Poor Prognosis ◽

Pedicle Subtraction Osteotomy ◽

Foot Drop ◽

Kyphotic Deformity ◽

Neurological Deficits ◽

Lower Extremity Function ◽

Lower Extremity Weakness ◽

Postoperative Course ◽

Extramedullary Tumor

The authors report a case in which multilevel thoracic pedicle subtraction osteotomy (PSO) was performed to correct post-laminectomy kyphotic deformity in a 9-year-old boy presenting with worsening lower-extremity neurological deficits. Five years prior to presentation, the patient underwent multilevel thoracolumbar laminectomies for resection of an atypical teratoid/rhabdoid tumor (AT/RT), a rare lesion that typically occurs intracranially and has a poor prognosis, making this particular presentation unusual and the patient's subsequent postoperative course remarkable. No fusion was undertaken at the time of resection, given the patient's age and presumptive poor prognosis. Over the next 5 years, the patient developed progressive thoracolumbar kyphotic deformity, with a Cobb angle greater than 110°, despite bracing, and bilateral lower-extremity weakness requiring ankle-foot orthotics for continued ambulation due to progressive foot drop. Worsening gait and the onset of respiratory issues prompted surgical intervention. Multilevel thoracic PSO and thoracolumbar fusion were performed, resulting in improved lower-extremity function and correction of the kyphotic deformity to approximately 65°. This report outlines an unusual AT/RT presentation and postoperative course and also discusses literature related to PSO within the context of pediatric kyphotic deformity. The authors' experience supports the use of multilevel PSO with fusion as a potential treatment option for significant pediatric thoracolumbar kyphotic deformity requiring surgical correction.

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Role of Multimodality Intraoperative Neurophysiological Monitoring during Embolisation of a Spinal Cord Arteriovenous Malformation

Interventional Neuroradiology ◽

10.1177/159101990000600308 ◽

2000 ◽

Vol 6 (3) ◽

pp. 223-234 ◽

Cited By ~ 14

Author(s):

F. Sala ◽

Y. Niimi ◽

A. Berenstein ◽

V. Deletis

Keyword(s):

Spinal Cord ◽

Mr Imaging ◽

General Anesthesia ◽

Endovascular Procedures ◽

Motor Evoked Potentials ◽

Neurological Deficits ◽

Neurophysiological Monitoring ◽

Thoracic Spinal Cord ◽

Lower Extremity Weakness ◽

Thoracic Spinal

The decision whether or not to embolise during endovascular procedures for arteriovenous malformations (AVMs) of the spinal cord under general anesthesia, relies primarily on neurophysiological results of provocative tests with Lidocaine and short-acting barbiturates. Because of the complex haemodynamics of spinal AVMs, when either sensory (CSEPs) or muscle motor evoked potentials (mMEPs) are used independently, they can mislead the interpretation of provocative tests. This report illustrates the specific but complementary role played by provocative tests using CSEPs and mMEPs during embolisation of a low thoracic spinal cord AVM. We present the case of a 46 year old male with six year history of right lower extremity weakness. At that time, Magnetic Resonance (MR) imaging of the spine disclosed an intramedullary AVM at T11. He remained neurologically stable up to seven months before admission, when he developed sudden onset of low back pain, followed by progressive paraparesis, numbness in lower extremities, urinary retention and fecal incontinence. A new MR imaging study indicated venous thrombosis of the AVM. A two-stage embolisation was performed. During the first procedure, after provocative tests did not affect either CSEPs or mMEPs, an embolisation was performed through a sulco-commisure feeder from the anterior spinal artery (ASA) at T9. Conversely, provocative tests with Lidocaine performed from a right posterior spinal artery (PSA) feeder to the AVM nidus resulted in a significant (>50%) decrease of CSEPs, while mMEPs remained unchanged. The repeatedly positive tests warranted further investigation of the vascular anatomy which disclosed a normal right PSA distal to the nidus; the distal normal PSA was protected with coils. A repeated Lidocaine test was negative and the posterior feeder was embolised with no subsequent changes in CSEPs or mMEPs. After the procedure, the patient experienced only a mild transitory increase in right leg numbness, but no additional motor deficits. Five days later, the embolisation through the ASA feeder at T9 was completed on the basis of negative provocative tests. No additional neurological deficits were observed. Favoring either CSEPs or MEPs during endovascular procedures in the spinal cord is not justified by a solid scientific background. This case report illustrates that monitoring both CSEPs and mMEPs combined with provocative tests allows the safest and most effective embolisation of spinal cord AVMs under general anesthesia.

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Spinal Intramedullary Metastasis of Breast Cancer

Case Reports in Medicine ◽

10.1155/2014/583282 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Recep Basaran ◽

Mehmet Tiryaki ◽

Dilek Yavuzer ◽

Mustafa Efendioglu ◽

Ece Balkuv ◽

...

Keyword(s):

Breast Cancer ◽

Lower Extremity ◽

Cancer Metastasis ◽

Breast Cancer Metastasis ◽

Neurological Deficits ◽

Histological Evaluation ◽

High Morbidity ◽

Intramedullary Metastasis ◽

Left Lower Extremity ◽

Thoracic Spinal

Objective.Breast cancer accounts for approximately one-third of all cancers in females. Approximately 8.5 % of all central nervous system metastases are located in the spinal cord. These patients have rapidly progressing neurological deficits and require immediate examination. The aim of surgery is decompression of neural tissue and histological evaluation of the tumor. In this paper, we present a case of breast cancer metastasis in thoracic spinal intramedullary area which had been partially excised and then given adjuvant radiotherapy.Case.A 43-year-old female patient with breast cancer for 8 years was admitted to our hospital with complaints of weakness in both legs. Eight years ago, she received chemotherapy and radiotherapy. On her neurological examination, she had paraparesis (left lower extremity: 2/5, right lower extremity: 3/5) and urinary incontinence. Spinal MRI revealed a gadolinium enhancing intramedullary lesion. Pathologic examination of the lesion was consistent with breast carcinoma metastasis. The patient has been taken into radiotherapy.Conclusion.Spinal intramedullary metastasis of breast cancer is an extremely rare situation, but it has a high morbidity and mortality rate. Microsurgical resection is necessary for preservation or amelioration of neurological state and also for increased life expectancy and quality.

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Microsurgical obliteration of a thoracic spinal perimedullary arteriovenous fistula

Neurosurgical FOCUS ◽

10.3171/2014.v3.focus14376 ◽

2014 ◽

Vol 37 (v2supplement) ◽

pp. Video13 ◽

Cited By ~ 1

Author(s):

Justin M. Caplan ◽

Mari Groves ◽

Ignacio Jusue-Torres ◽

Jennifer E. Kim ◽

Jason Liauw ◽

...

Keyword(s):

Lower Extremity ◽

Arteriovenous Fistula ◽

Urinary Retention ◽

Arteriovenous Malformations ◽

Vascular Lesions ◽

Intraoperative Angiography ◽

Lower Extremity Weakness ◽

Arteriovenous Fistulas ◽

Thoracic Spinal ◽

Dural Arteriovenous Fistulas

Spinal vascular lesions are rare and may be classified as a) dural arteriovenous fistulas (AVFs), b) arteriovenous malformations, or c) perimedullary AVFs. In this narrated video illustration, we present the case of a 71-year-old woman who presented with progressive bilateral lower extremity weakness and urinary retention who was diagnosed with a thoracic spinal perimedullary arteriovenous fistula. The diagnostic studies included a thoracic MRI and spinal angiogram. A multilevel thoracic laminoplasty was performed for microsurgical obliteration of the AVF. The techniques of intraoperative angiography, thoracic laminoplasty and microsurgical obliteration and resection of the AVF are reviewed.The video can be found here: http://youtu.be/5vVp3oq5sLg.

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Multimodal intrathecal analgesia in refractory cancer pain

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.10.002 ◽

2017 ◽

Vol 14 (1) ◽

pp. 39-43 ◽

Cited By ~ 10

Author(s):

Thierry C. Mastenbroek ◽

Bianca J. Kramp-Hendriks ◽

Jan Willem Kallewaard ◽

Johanna M. Vonk

Keyword(s):

Pain Management ◽

Side Effects ◽

Lower Extremity ◽

Cancer Pain ◽

Dose Adjustment ◽

Pain Treatment ◽

World Health ◽

Neurological Deficits ◽

Intrathecal Therapy ◽

Lower Extremity Weakness

AbstractBackground and aimsCancer pain treatment has improved over the last decades. The majority of this population can be treated effectively with analgesics following the Guidelines of the original World Health Organisation (WHO). Unfortunately 10–15% of these patients still suffer from severe and refractory cancer pain, especially in the terminal phases of disease and require additional pain management modalities. Therefore, end-stage clinical interventions are particularly needed to minimize the perception of pain. With intrathecal therapy (ITT), drugs are delivered close to their site of action in the central nervous system avoiding first-pass metabolism and blood–brain barrier. It may improve analgesia with a smaller dose and possibly achieve a reduction in systemic or cerebral side effects compared to oral supplied medication alone. Multimodal analgesia enables further dose reduction with improved analgesia and fewer side effects.MethodsIn this retrospective research we investigated the effectiveness and side-effect profile of intrathecal morphine, bupivacaine and clonidine. Patients were followed until death occurred. Pain scores and side effects were recorded before initiating ITT (T0), just after initiating ITT (T1), at hospital discharge (T2), in the ambulant setting (T3) and the last obtained scores before death occurred (T4).ResultsNine patients were included who suffered from severe and refractory cancer pain, not reacting to conventional pain management or had intolerable side effects. Primary tumour location was pancreatic (4), urothelial (3) and prostate (2). Primary pain was considered neuropathic or mixed neuropathic-nociceptive. The treatment team consisted of an anaesthetist, specialized nurse in coordination with primary physician, treating oncologist and specialized home care.All patients were free of pain after initiation of the intrathecal therapy. The average follow-up period was 11 weeks in which there was a slight increase in NRS-score. In the last days before death occurred, half the patients were still free of pain. There were no problems during insertion of the catheter, device malfunction or infection. No severe adverse events defined as hypotension requiring inotropes, respiratory depression or neurological deficits were observed. Three patients experienced mild hypotension which gradually decreased after clonidine dose adjustment. Lower extremity weakness occurred in three patients as well. After bupivacaine dose adjustment the weakness disappeared in two patients and in one patient the lower extremity weakness persisted as a result of conus compression by tumour.Conclusion and implicationsMultimodal IT treatment with morphine, bupivacaine and clonidine is effective and safe for treating refractory cancer pain in the terminal phase of disease.The study offers an important contribution to literature where there is still lack of convincing evidence about the benefits and harms of this type of pain management in patients with otherwise refractory cancer pain.

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Conus medullaris syndrome without lower-extremity involvement in L-1 burst fractures

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.3.265 ◽

2006 ◽

Vol 4 (3) ◽

pp. 265-269 ◽

Cited By ~ 5

Author(s):

Dean Chou ◽

Roger Hartl ◽

Volker K. H. Sonntag

Keyword(s):

Lower Extremity ◽

Conus Medullaris ◽

Neurological Deficits ◽

Neurological Injury ◽

Motor Weakness ◽

Burst Fractures ◽

Sensory Changes

✓ Conus medullaris injury from burst fractures is known to occur in conjunction with other neurological deficits, including lower-extremity motor weakness or sensory changes. Rarely does an isolated conus medullaris injury occur from an extradural cause without other neurological deficits. The authors report four cases of L-1 burst fractures in which conus medullaris dysfunction was the sole neurological injury in the absence of lower-extremity involvement.

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