scholarly journals The lateral infratrigeminal transpontine window to deep pontine lesions

2015 ◽  
Vol 123 (3) ◽  
pp. 699-710 ◽  
Author(s):  
Paolo Ferroli ◽  
Marco Schiariti ◽  
Roberto Cordella ◽  
Carlo Boffano ◽  
Simone Nava ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Intervention ◽  
Neurological Deficits ◽  
Critical Area ◽  
Surgical Indications ◽  
Surgical Strategies ◽  
Csf Leakage ◽  
New Knowledge ◽  
Pontine Lesion

OBJECT Surgery of brainstem lesions is increasingly performed despite the fact that surgical indications and techniques continue to be debated. The deep pons, in particular, continues to be a critical area in which the specific risks related to different surgical strategies continue to be examined. With the intention of bringing new knowledge into this important arena, the authors systematically examined the results of brainstem surgeries that have been performed through the lateral infratrigeminal transpontine window. METHODS Between 1990 and 2013, 29 consecutive patients underwent surgery through this window for either biopsy sampling or for removal of a deep pontine lesion. All of this work was performed at the Department of Neurosurgery of the Istituto Nazionale Neurologico "Carlo Besta", in Milan, Italy. A retrospective analysis of the findings was conducted with the intention of bringing further clarity to this important surgical strategy. RESULTS The lateral infratrigeminal transpontine window was exposed through 4 different approaches: 1) classic retrosigmoid (15 cases), 2) minimally invasive keyhole retrosigmoid (10 cases), 3) translabyrinthine (1 case), and 4) combined petrosal (3 cases). No deaths occurred during the entire clinical study. The surgical complications that were observed included hydrocephalus (2 cases) and CSF leakage (1 case). In 6 (20.7%) of 29 patients the authors encountered new neurological deficits during the immediate postoperative period. All 6 of these patients had undergone lesion removal. In only 2 of these 6 patients were permanent sequelae observed at 3 months follow-up. These findings show that 93% of the patients studied did not report any permanent worsening of their neurological condition after this surgical intervention. CONCLUSIONS This retrospective study supports the idea that the lateral infratrigeminal transpontine window is both a low-risk and safe corridor for either biopsy sampling or for removal of deep pontine lesions.

scholarly journals Progressive Scoliosis and Syringomyelia - Questions of Surgical Approach

Folia Medica ◽  
2018 ◽  
Vol 60 (2) ◽  
pp. 261-269 ◽  
Author(s):  
Mikhail Mikhaylovskiy ◽  
Vyacheslav Stupak ◽  
Vadim Belozerov ◽  
Nikolay Fomichev ◽  
Anatoliy Lutsik ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Surgical Correction ◽  
Neurological Deficits ◽  
Spinal Deformities ◽  
Loss Of Correction ◽  
Scoliotic Deformity ◽  
Scoliosis Correction ◽  
The Moment ◽  
Comparison Of The Results

Abstract Background: The rate of scoliosis in syringomyelia patients ranges from 25 to 74.4%. In turn, syringomyelia occurs in 1.2% to 9.7% of scoliosis patients. Aim: To evaluate outcomes of surgical correction of the scoliotic deformity in syringomyelia patients. Materials and methods: Between 1996 and 2015, 3120 patients with scoliosis of various etiologies were treated at the Clinic for Child and Adolescent Vertebrology of the Novosibirsk Research Institute of Traumatology and Orthopedics. We conducted a retrospective analysis of syringomyelia-associated scoliosis cases that required surgical correction. Results: Syringomyelia was found in 33 patients (1.05%) out of 3120 patients with spinal deformities of various etiologies; in 21 patients (0.9%) with idiopathic scoliosis of 2334 patients. In identifying the neurological deficit, the recommended first step is to perform neurosurgery. Nineteen patients were operated using the CDI, 4 patients underwent correction VEPTR, in 1 case instrumentation could not be established, 9 patients are undergoing treatment in the department of neurosurgery at the moment. Worsening of neurological deficits was not observed in any patient. Conclusion: A comparison of the results of syringomyelia-associated scoliosis correction with the data of other authors was done. The choice of surgery tactics is strictly individual and depends on the size of the cavity. The result of surgical intervention is generally positive and the loss of correction by the end of follow-up is negligible.

Kirschner Pin Migration Associated with the Sliding Genioplasty

1993 ◽  
Vol 10 (1) ◽  
pp. 15-19
Author(s):  
David J. Gingrass
Keyword(s):  
Retrospective Study ◽  
Bone Plates ◽  
Surgical Indications ◽  
Common Procedure ◽  
Vertical Movements ◽  
Medical College ◽  
Advantages And Disadvantages ◽  
Fixation Techniques ◽  
The Mean

The sliding genioplasty for cosmetic augmentation of microgenia is a common procedure performed by maxillofacial and cosmetic surgeons. There are multiple designs for this osteotomy, and multiple fixation techniques proposed, among which include wires, screws, bone plates, and pins. Likewise, there are many advantages and disadvantages to each of the designs and the fixation techniques that will be utilized according to the surgical indications and the surgeon's preference. A techique used at the Medical College of Wisconsin in Milwaukee involves fixation of the osteotomy segments with Kirschner pins placed at multiple divergent angles. This technique allows for placement of the free segments in virtually any location, and provides for a type of rigid stabilization, particularly in large anterior and vertical movements. One criticism that has been suggested with the use of Kirschner pins is the possibility of migration. This retrospective study evaluates 13 patients who underwent augmentation genioplasty, rigidly fixated with Kirschner pins. Twenty-eight total Kirschner pins were placed, with one being removed. The mean postoperative follow-up was 32 months, and the average number of pins placed was 2.15 per patient. It would appear then, from this study, that migration of Kirschner pins when used with the sliding genioplasty, is not a significant postoperative concern.

Healing rates following venous surgery for chronic venous leg ulcers in an independent specialist vein unit

2013 ◽  
Vol 28 (3) ◽  
pp. 132-139 ◽  
Author(s):  
C A Thomas ◽  
J M Holdstock ◽  
C C Harrison ◽  
B A Price ◽  
M S Whiteley
Keyword(s):  
Retrospective Study ◽  
Clinical Improvement ◽  
Ulcer Healing ◽  
Surgical Intervention ◽  
Response Rate ◽  
Significant Proportion ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Venous Surgery

Objectives This is a retrospective study over 12 years reporting the healing rates of leg ulcers at a specialist vein unit. All patients presented with active chronic venous leg ulcers (clinical, aetiological, anatomical and pathological elements [CEAP]: C6) and had previously been advised elsewhere that their ulcers were amenable to conservative measures only. Method Seventy-two patients (84 limbs) were treated between March 1999 and June 2011. Patients were contacted in August 2011 by questionnaire and telephone. Of 72 patients, two were deceased and two had moved location at follow-up, so were not contactable. Fifty patients replied and 18 did not (response rate 74%), representing a mean follow-up time of 3.1 years. Results Ulcer healing occurred in 85% (44 of 52 limbs) of which 52% (27) limbs were no longer confined to compression. Clinical improvement was achieved in 98% of limbs. Conclusions This study shows that a significant proportion of ulcers currently managed conservatively can be healed by surgical intervention.

scholarly journals Osteoid Osteoma and Osteoblastoma of the Cervical Spine: The Cause of Unusual Persistent Neck Pain

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 549-554
Author(s):  
Tuncay Kaner
Keyword(s):  
Cervical Spine ◽  
Retrospective Study ◽  
Neck Pain ◽  
Osteoid Osteoma ◽  
Tumor Resection ◽  
Spinal Instrumentation ◽  
The Other ◽  
Neurological Deficits ◽  
Common Symptom

Background: The most important symptom in patients with osteoid osteoma and osteoblastoma is a resistant localized neck pain and stiffness in the spine. Objective: To evaluate and analyze 6 cases of osteoid osteoma and osteoblastoma of the cervical spine that were surgically treated over a 7-year period and to emphasize the unusual persistent neck pain associated with osteoid osteoma and osteoblastoma of the cervical spine. Study Design: Retrospective study. Methods: Six patients, 3 male and 3 female, with a mean age of 21 years (range 16-31) diagnosed with osteoid osteoma or osteoblastoma during 2003 to 2009 were analyzed retrospectively. The preoperative neurological and clinical symptoms, neck pain duration, preoperative deformity, location of lesion, radiological findings, surgical technique and clinical follow-up outcomes of each patient were evaluated. Results: The average follow-up duration was 40.5 months (range, 19 to 83 months). Three patients had osteoid osteoma (2 female and one male), and 3 patients had osteoblastoma (one female and 2 male). Two male patients had recurrent osteoblastoma. The locations of the lesions were as follows: C7 (2 patients), C3 (one patient), C2 (one patient), C3-C4 (one patient) and C5-C6 (one patient). The most common symptom was local neck pain in the region of the tumor. Among all patients, only one patient, who had osteoblastoma, had neurological deficits (right C5-C6 root symptoms). The other patients had no neurological deficits. All patients were treated with surgical resection using microsurgery. Two patients underwent only tumor resection, one patient underwent tumor resection and fusion, and the other 3 patients underwent tumor resection, fusion and spinal instrumentation. No perioperative complications developed in any of our patients. There was no tumor recurrence during the follow-up period. Limitations: A retrospective study with 6 analyses of cases. Conclusion: Surgical treatment of osteoid osteoma and osteoblastoma of the spine has been standardized. The most common symptom of osteoid osteoma and osteoblastoma of the cervical spine is local persistent neck pain in the region of the tumor. This symptom can be significant in the diagnosis of these tumors. Key words: neck pain, osteoid osteoma, osteoblastoma, bone tumors, cervical spine

scholarly journals Endoscopic posterior cordotomy for treatment of dyspnea due to vocal fold immobility

2020 ◽  
Vol 15 ◽  
Author(s):  
Narin Nard Carmel Neiderman ◽  
Max Chason ◽  
Anat Wengier ◽  
Oshri Wasserzug ◽  
Oren Cavel ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Respiratory Distress ◽  
Surgical Procedures ◽  
Medical Records ◽  
Vocal Fold ◽  
Surgical Intervention ◽  
Acute Setting ◽  
Vocal Fold Immobility ◽  
The Mean

Introduction: Several surgical procedures have been described for the treatment of respiratory distress secondary to vocal fold immobility (VFI), but the contribution of posterior cordotomy (PC) to tracheostomy weaning or prevention has not been studied in depth, particularly in the acute setting. The objective of this study was to show the effectiveness of PC to relieve dyspnea, prevent the need for tracheostomy, and enable decannulation in patients with VFI. Methods: We conducted a retrospective study and reviewed the medical records of all patients whose dyspnea warranted surgical intervention from January 2013 to January 2018. Data were retrieved on epidemiology, etiology, and duration of VFI, tracheostomy dependence, success in decannulation from tracheostomy or respiratory relief, number of procedures until decannulation, and complications. Results: Twelve suitable patients were identified of whom eleven had bilateral VFI and one had unilateral VFI. Five were tracheostomy-dependent. Ten patients underwent unilateral PC, and two patients underwent bilateral PC. All the patients experienced respiratory relief, eleven after a single PC and one after two PCs. All tracheostomy-dependent patients were decannulated. The mean follow-up after PC was 24.55 months during which none of the patients required a re-tracheostomy and three patients required revision of the PC. There were no surgical complications. Postoperatively, eight patients (67%) experienced a breathy voice and three patients (25%) had dysphagia for fluids. No patient had aspiration pneumonia. Conclusions: We conclude that PC is an easy, safe, and effective procedure for tracheostomy weaning and respiratory relief in patients with VFI. A revision PC may be indicated in some patients. A breathy voice is to be expected, and a few patients will experience dysphagia to fluids that may be addressed by instructing the patient to use a fluid thickener and take small sips.

Cervical vertebral fractures in 56 dogs: a retrospective study

1999 ◽  
Vol 35 (2) ◽  
pp. 135-146 ◽  
Author(s):  
JC Hawthorne ◽  
WE Blevins ◽  
LJ Wallace ◽  
N Glickman ◽  
DJ Waters
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Functional Recovery ◽  
Vertebral Fractures ◽  
Perioperative Period ◽  
Clinicopathological Features ◽  
Neurological Deficits ◽  
Perioperative Mortality ◽  
Cervical Fractures

The clinicopathological features of cervical fractures in 56 dogs were reviewed. "Hit by car" (HBC) was the most common inciting cause, and the axis and atlas were the vertebrae most frequently affected. Surgical treatment was associated with high (36%) perioperative mortality. However, all dogs that survived the perioperative period achieved functional recovery. Functional recovery was achieved in 25 (89%) of 28 nonsurgically treated dogs with adequate follow-up. Overall, severity of neurological deficits (nonambulatory status) and prolonged interval (five days or longer) from trauma to referral were associated with poorer outcome. Nonsurgical treatment is a viable therapeutic approach for many dogs with cervical fractures. Early neck immobilization and prompt referral are recommended, because delay in referral decreases the likelihood of functional recovery.

scholarly journals Halo traction combined with posterior-only approach correction for cervical kyphosis with Neurofibromatosis-1: minimum 2 years follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hongqi Zhang ◽  
Ang Deng ◽  
Chaofeng Guo ◽  
Zhenhai Zhou ◽  
Lige Xiao
Keyword(s):  
Posterior Instrumentation ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Cervical Kyphosis ◽  
Fusion Surgery ◽  
Surgical Strategies ◽  
Kyphosis Correction ◽  
Halo Traction ◽  
Correction Result

Abstract Background Surgical management of cervical kyphosis in patients with NF-1 is a challenging task. Presently, anterior-only (AO), posterior-only (PO) and combined anterior-posterior (AP) spinal fusion are common surgical strategies. However, the choice of surgical strategy and application of Halo traction remain controversial. Few studies have shown and recommended posterior-only approach for cervical kyphosis correction in patients with NF-1. The aim of this study is to evaluate the safety and the effectiveness of halo Traction combined with posterior-only approach correction for treatment of cervical kyphosis with NF-1. Methods Twenty-six patients with severe cervical kyphosis due to NF-1 were reviewed retrospectively between January 2010 and April 2018. All the cases underwent halo traction combined with posterior instrumentation and fusion surgery. Correction result, neurologic status and complications were analyzed. Results In this study, cervical kyphosis Cobb angle decreased from initial 61.3 ± 19.7 degrees to postoperative 10.6 ± 3.7 degrees (P<0.01), with total correction rate of 82.7%, which consist of 45.8% from halo traction and 36.9% from surgical correction. JOA scores were improved from preoperative 13.3 ± 1.6 to postoperative 16.2 ± 0.7 (P<0.01). Neurological status was also improved. There was no correction loss and the neurological status was stable in mean 43 months follow-up. Three patients experienced minor complications and one patient underwent a second surgery. Conclusion Halo traction combined with PO approach surgery is safe and effective method for cervical kyphosis correction in patients with NF-1. A satisfied correction result, and successful bone fusion can be achieved via this procedure, even improvement of neurological deficits can also be obtained. Our study suggested that halo traction combined with PO approach surgery is another consideration for cervical kyphosis correction in patients with NF-1.

Successful obliteration of troublesome and chronically draining cavities

2017 ◽  
Vol 131 (2) ◽  
pp. 138-143 ◽  
Author(s):  
S Geerse ◽  
F A Ebbens ◽  
M J F de Wolf ◽  
E van Spronsen
Keyword(s):  
Retrospective Study ◽  
Revision Surgery ◽  
Surgical Outcomes ◽  
Recurrent Disease ◽  
Patient Characteristics ◽  
Surgical Indications ◽  
Mastoid Obliteration ◽  
Total Cohort ◽  
Radical Cavity

AbstractObjective:This study aimed to evaluate the results of revision radical cavity surgery with mastoid obliteration using a standardised grading scheme.Methods:A retrospective study was performed of 121 patients (122 ears) with chronically draining ears who underwent revision radical cavity surgery with mastoid obliteration between 2007 and 2013. Surgical indications, patient characteristics, pre- and post-operative Merchant grade, and surgical outcomes were recorded. The main outcome measures were presence of a dry ear, time for complete re-epithelialisation, presence of residual or recurrent disease, and need for revision surgery.Results:In the 5-year follow-up group (n = 31), dry ears were found in 97 per cent after 6 minor revisions and cholesteatoma-free ears were found in 97 per cent. In the total cohort, dry ears were found in 93 per cent after nine revisions and cholesteatoma-free ears were found in 98 per cent. The median time for complete re-epithelialisation was eight weeks. There were no major complications.Conclusion:In terms of the dry ear rate, residual cholesteatoma and time to complete epithelialisation, revision radical cavity surgery with mastoid obliteration produces very good results in concordance with published results, despite most patients suffering from very troublesome cavities prior to surgery.

Surgical management of craniopharyngiomas

1986 ◽  
Vol 65 (1) ◽  
pp. 22-27 ◽  
Author(s):  
David S. Baskin ◽  
Charles B. Wilson
Keyword(s):  
Tumor Size ◽  
Surgical Intervention ◽  
Neurological Deficits ◽  
Direct Result ◽  
Content Type ◽  
Fair Result ◽  
Transcallosal Approach ◽  
Common Presentation ◽  
Fine Print

✓ A series of 74 patients with craniopharyngiomas were treated during a 15-year period. Of the 74 patients, 40 were males and 34 were females, with a mean age of 27 years (range 3 to 65 years). Twenty-eight patients (38%) were less than 18 years of age. Remission was defined as clinical improvement with stable ophthalmological and neurological status, radiological evidence of a decrease in tumor size, and either a continued decrease or a stable tumor size on follow-up radiological evaluations. A fair result was considered remission with new neurological deficits related to surgical intervention. All other results were considered a failure. The mean follow-up period in this study was 4 years, with 100% of the patients monitored. In children, the most common presentation was that of growth failure (93%). In adults, sexual dysfunction was the most common presentation, with 88% of males presenting with impotence or marked decrease in sexual drive, and 82% of females presenting with primary or secondary amenorrhea, often associated with galactorrhea. Considering the pediatric and adult populations together, the most common presenting symptom was visual dysfunction, with 71% of patients presenting in this manner. Fifty percent of patients presented with severe headache. The most frequent preoperative finding was a visual field defect, with 72% of patients so affected; 42% of patients had preoperative hypothyroidism and 24% had hypoadrenalism. Diabetes insipidus was present preoperatively in 23%. Hydrocephalus was uncommon, being present in only 15%. A subfrontal craniotomy was used in 47% of patients, a transsphenoidal approach in 39%, a subtemporal approach in 11%, a transcallosal approach in 5%, and a suboccipital craniectomy in 2%. Multiple procedures were required in 15% of patients in order to provide significant relief of compressive symptomatology. The results of therapy indicate that total tumor removal was deemed to have been achieved in only seven patients, six of whom have had no recurrence. However, 91% of patients are in remission, one had a fair result, and two died as a direct result of surgical intervention. One patient died from uncontrolled disease, and three patients died from unrelated causes. The results of this study indicate that radical subtotal removal followed by radiotherapy is an acceptable treatment for craniopharyngioma.

scholarly journals Spontaneous Transtemporal CSF Leakage: A Study of 51 Cases

2005 ◽  
Vol 84 (11) ◽  
pp. 700-706 ◽  
Author(s):  
John P. Leonetti ◽  
Sam Marzo ◽  
Douglas Anderson ◽  
Thomas Origitano ◽  
Daniel D. Vukas
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Retrospective Study ◽  
Tertiary Care ◽  
Middle Fossa ◽  
Resonance Imaging ◽  
Csf Leakage ◽  
Subtotal Petrosectomy

We conducted a retrospective study of 51 cases of spontaneous transtemporal cerebrospinal fluid (CSF) leakage in 48 adults who had presented to our tertiary care academic referral center between July 1, 1988, and June 30, 2002. All patients had undergone high-resolution temporal bone computed tomography, and 26 patients had undergone magnetic resonance imaging. All patients were treated with a middle fossa craniotomy to repair the CSF fistulae. During a mean follow-up of 4.9 years, 46 of the 48 patients (95.8%) had experienced a complete cessation of CSF leakage (49 of 51 cases [96.1%]). The 2 patients whose leakage recurred were successfully managed with a subtotal petrosectomy with occlusion of the eustachian tube and obliteration of the middle ear and mastoid. No patient developed meningitis.

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